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The investigation of efficacy and safety about the clinical pathway for congestive heart failure specified immediate use of tolvaptan after admission in super-elderly patients.

Session Poster Session 3

Speaker Yuichi Kato

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure: Pharmacotherapy
  • Session type : Poster Session

Authors : Y Kato (Kagawa,JP), A Takaishi (Kagawa,JP), T Nakayama (Kagawa,JP), K Yasuhara (Kagawa,JP), N Matsuo (Kagawa,JP), M Tanimoto (Kagawa,JP), K Kagawa (Kagawa,JP), Y Nakano (Kagawa,JP), N Onishi (Kagawa,JP), S Hirohata (Okayama,JP), M Ueeda (Kagawa,JP)

Y Kato1 , A Takaishi1 , T Nakayama1 , K Yasuhara1 , N Matsuo1 , M Tanimoto1 , K Kagawa1 , Y Nakano1 , N Onishi1 , S Hirohata2 , M Ueeda3 , 1Mitoyo General Hospital, cardiocascular - Kagawa - Japan , 2Okayama University, Postgraduate school of medicine - Okayama - Japan , 3Ueeda Cardiovascular medicine clinic - Kagawa - Japan ,


Background: In Japan, for congestive heart failure(CHF) cases we had been able to prescribe new and strong diuretic, Tolvaptan from 2010. We introduced original clinical pathway with immediate use of Tolvaptan after admission for chronic heart failure cases(CHF-PATH) from August 2015, and confirmed its large shortening effect of hospitalization period by efficient medical treatment. We often apply CHF-PATH even in super-elder patients with CHF.

Purpose: we verified the usefulness and safety of CHF-PATH use in super-elder patients with CHF.

Method: We enrolled 376 CHF patients, with clear pulmonary congestion findings in their chest X-ray, who admitted in our hospital and applied CHF-PATH for the first time between August 2015 to November 2018 (mean age:80.6+/-10.8 years old, male/female:193/183). We divided them into two groups, 73 cases who were 90 years old or older(E-group; mean age: 92.8+/-2.5 years old, male/female: 33/39), and 303 cases who are less than 89 years old(Y-group; mean age: 77.7+/-10.0 years old, male/female: 160/143). We examined their clinical characteristics, various situation of their medical care and incidence of adverse events that might influence use continuation of Tolvaptan such as more worsening of renal function or hypernatremia after admission.

Results:In E-group the ejection fraction of left ventricle by echocardiography was higher(56+/-15 vs 48+/-19%; p<0.01), the mean renal function(eGFR) on admission was lower(39+/-18 vs 48+/-20 mL/min; p<0.01) and the prevalence of dementia was higher(81 vs 56%; p<0.001) than that in Y-group. In E-group and Y-group, the performance rate of continuous venous infusion(71 vs 66%; NS) and its mean performance duration(5.5+/-7.5 vs 4.7+/-5.4 days; NS), the performance rate of urethral catheterization(45 vs 47%; NS) and its mean duration(6.6+/-6.7 vs 5.9+/-7.97 days; NS) and mean starting time of cardiac rehabilitation after admission(3.1+/-1.6th vs 2.9+/-1.5th day; NS) were not different. The mean hospitalization period was longer in E-group (20.6+/-19.1 vs 15.5+/-11.6days; p<0.05). In E-group the serious worsening of renal function or hypernatremia which needed to stop use of Tolvaptan occurred more often(15.1 vs 3.0 %; p<0.001). The CHF re-admission rate within 1 year after discharge was not different in E-group and Y-group(32 vs 26%; NS).

Even in Super-elderly patients with congestive heart failure, each medical care was performed efficiently by our original clinical pathway and there was not significant difference about re-admission rate with the worsening of heart failure between two groups. But we thought that considering peculiar factors of elderly patients such as existence of renal dysfunction or dementia, we should be careful to occurrence of adverse events related to use of Tolvaptan in super-elderly cases introduced our original clinical pathway.

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