Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan.
BMC Cardiovasc Disord. 2022 Apr 29;22(1):202. doi: 10.1186/s12872-022-02640-7.
Elderly patients with heart failure (HF) have been observed to decrease activities of daily living (ADL) during hospitalization. Prevention of ADL decline from shortening of hospital stays is especially important in the elderly, because decreasing ADL is associated with poor prognosis. We investigated the relationship between the early initiation of tolvaptan (TLV) after hospitalization and the length of hospital stay in patients with HF aged younger than 80 years and aged 80 years and older.
We analyzed 146 patients younger than 80 years (< 80) and 101 patients aged 80 years and older (≥ 80) who were hospitalized with HF from February 2011 to June 2016 and had initiated TLV. The relationship between the time until commencement of TLV and the length of hospital stay was assessed. Additionally, a comparison made between the TLV early start group (within the median) and the delayed start group (over the median) for both groups. Multivariate analysis was also performed on factors that required hospital stays below the median.
A significant correlation was observed between time to TLV initiation and the length of hospital stay (< 80: r = 0.382, P < 0.001; ≥ 80: r = 0.395, P < 0.001). The length of hospital stay in the early group was significantly longer than that in the delayed group for both groups (< 80: early 21.0 ± 13.0 days and 33.0 ± 22.7 days, respectively, P < 0.001; ≥ 80: early 21.3 ± 12.5 days and 32.9 ± 17.9 days, respectively, P < 0.001). Conversely, no statistically significant difference found in the length of hospital stay after initiation of TLV. Moreover, no increase in adverse events in the elderly observed. A multivariate analysis revealed that a predictive factor for short-term hospitalization was early administration of TLV regardless of age.
The early initiation of TLV after hospitalization was associated with a shorter length of hospital stay in patients with HF regardless of age.
心力衰竭（HF）老年患者在住院期间观察到日常生活活动（ADL）减少。在老年人中，预防 ADL 下降导致住院时间缩短尤为重要，因为 ADL 下降与预后不良有关。我们调查了住院后托伐普坦（TLV）早期开始与年龄小于 80 岁和 80 岁及以上 HF 患者住院时间的关系。
我们分析了 2011 年 2 月至 2016 年 6 月因 HF 住院且开始使用 TLV 的 146 例年龄小于 80 岁（<80 岁）和 101 例年龄 80 岁及以上（≥80 岁）的患者。评估了从开始使用 TLV 到住院时间的关系。此外，还比较了两组 TLV 早期开始组（中位数内）和延迟开始组（中位数以上）的情况。还对需要住院时间短于中位数的因素进行了多变量分析。
TLV 开始时间与住院时间之间存在显著相关性（<80 岁：r=0.382，P<0.001；≥80 岁：r=0.395，P<0.001）。两组中，早期组的住院时间明显长于延迟组（<80 岁：早期 21.0±13.0 天和 33.0±22.7 天，P<0.001；≥80 岁：早期 21.3±12.5 天和 32.9±17.9 天，P<0.001）。相反，在开始使用 TLV 后，住院时间没有统计学上的显著差异。此外，未观察到老年患者不良事件增加。多变量分析显示，无论年龄大小，短期住院的预测因素均为早期使用 TLV。
无论年龄大小，住院后早期使用 TLV 与 HF 患者住院时间缩短有关。
