Cardiovascular Center, Anjo Kosei Hospital, Anjo, Japan.
Department of Advanced Cardiovascular Therapeutics, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Nagoya J Med Sci. 2021 Aug;83(3):431-441. doi: 10.18999/nagjms.83.3.431.
Worsening heart failure (WHF) has a negative impact on the prognosis of patients with heart failure. Adequate management of non-hospitalized episodes of WHF, regarded as "outpatient WHF", may reduce the frequency of emergent/urgent hospitalization for acute heart failure; thus, the patients' cardiac parameters return to their clinical baseline. This study aimed to investigate the efficacy of tolvaptan initiation during planned hospitalization of patients with "outpatient WHF" through hospital and clinic cooperation. The data from 28 patients with outpatient WHF referred by general practitioners to hospital were assessed. Tolvaptan administration was initiated during planned hospitalization and continued in the clinics. Patients were followed-up for 12 months. None of the patients required withdrawal of tolvaptan due to adverse effects. During the follow-up period, the loop diuretic dosage significantly decreased. There were significant favorable changes in the levels of serum creatinine, estimated glomerular filtration rate, natriuretic peptide and body weight. Kaplan-Meier survival analysis revealed that the cardiac death- and HF-related hospitalization-free survival rates were significantly higher among the patients who were administered tolvaptan for the outpatient WHF than the propensity score-matched patients who were administered tolvaptan for acute heart failure requiring emergent/urgent hospitalization. In conclusion, tolvaptan may be safe and effective for the long-term management of outpatient WHF through hospital and clinic cooperation.
心力衰竭恶化（WHF）对心力衰竭患者的预后有负面影响。充分管理非住院的 WHF 发作，即“门诊 WHF”，可降低因急性心力衰竭而紧急/紧急住院的频率；从而使患者的心脏参数恢复到临床基线。本研究旨在通过医院和诊所合作，调查在计划住院的门诊 WHF 患者中起始托伐普坦的疗效。评估了由全科医生转介至医院的 28 例门诊 WHF 患者的数据。在计划住院期间开始给予托伐普坦，并在诊所继续治疗。对患者进行了 12 个月的随访。由于不良反应，没有患者需要停用托伐普坦。在随访期间，袢利尿剂的剂量显著减少。血清肌酐、估计肾小球滤过率、利钠肽和体重水平均有显著的有利变化。Kaplan-Meier 生存分析显示，与因需要紧急/紧急住院的急性心力衰竭而给予托伐普坦的倾向评分匹配患者相比，接受托伐普坦治疗门诊 WHF 的患者的心脏死亡和心力衰竭相关住院无事件生存率显著更高。总之，托伐普坦通过医院和诊所合作，可能对门诊 WHF 的长期管理安全且有效。
