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A low dose Pimobendan was observed to prolong the period until re-hospitalization for Japanese patients with advanced heart failure, especially in the vulnerable post-discharge period.

Session Poster Session 3

Speaker Kazuhisa Kodama

Event : Heart Failure 2019

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

Authors : K Kodama (Kumamoto,JP), N Dohi (Tokyo,JP), T Murata (Tokyo,JP), Y Sano (Tokyo,JP), T Yokoi (Tokyo,JP), M Nakano (Tokyo,JP), T Sakamoto (Kumamoto,JP), K Nakao (Kumamoto,JP)

Authors:
K Kodama1 , N Dohi2 , T Murata3 , Y Sano2 , T Yokoi2 , M Nakano2 , T Sakamoto1 , K Nakao1 , 1Saiseikai Kumamoto Hospital, Cardiology - Kumamoto - Japan , 2TOA EIYO LTD., Medical Affairs - Tokyo - Japan , 3Crecon Medical Assessment Inc. - Tokyo - Japan ,

On behalf: PREFER study

Citation:

Background
One of the therapeutic goals in treatment of patients with advanced heart failure is prevention of re-hospitalization. The oral calcium sensitizer Pimobendan is one of the drugs expected to show efficacy in this situation.
Purpose
We investigated whether Pimobendan could contribute to prolongation of the period until re-hospitalization for heart failure and decrease the frequency of hospitalization. (UMIN 000034228)
Methods
This retrospective cohort study is based on anonymized  electronic health records from acute-care hospitals in Japan as gathered during the period April 2008 – February 2018. 
Patients who experienced two or more hospitalizations for heart failure during the observation period were enrolled. Patients were allocated to one of two groups. In one of the groups patients continued to receive Pimobendan on an outpatient basis, whereas patients in the other group were not prescribed Pimobendan upon discharge from hospital. The one-to-one propensity-score matching and IPTW methods were used to balance patient characteristics in these 2 groups.
Results
We identified 10,258 patients who satisfied our inclusion and exclusion criteria. Out of those 473 patients were prescribed Pimobendan during the follow-up period, whereas Pimobendan was not prescribed for 9,785 patients, who constitute the control group. 
276 propensity score matched pairs were identified for Pimobendan group versus control group. Mean age?±?standard deviation [SD] was 74.3?±?10.9 and 74.4?±?11.3 years, Male was 65.2 and 67.8 %, NYHA class 3 or 4 was 68.1 and 66.0 %, atrial fibrillation observed 60.5 and 62.0 % for Pimobendan group and control group, respectively. The cumulative incidence of heart failure hospitalization at 1 year was 0.35 (95% confidence interval [CI] 0.30 - 0.42) in Pimobendan group, and it was significantly lower than the control group (0.51, 95% CI 0.45 - 0.58) (p <0.002). Similar result about prolongation of period to rehospitalization for heart failure by Pimobendan observed by IPTW method.

The number of hospitalizations due to heart failure at 1 year was 0.5 ± 1.0 for the Pimobendan group, which was significantly less than for the control group (0.8 ± 1.3, p=0.021) as revealed by the Propensity score match method. No significant difference, however, was observed by the IPTW method(0.5±1.0 vs 0.6±1.0, p=0.532). Accordingly, it is a controversial issue whether Pimobendan can decrease hospitalization frequency.
The cumulative incidence of hospitalizations due to life-threatening arrhythmia was 6.41 (95%CI 1.45 – 11.37] and 2.41 (95% CI -0.63 – 5.45) /1000 person-year for the Pimobendan group and the control group, respectively. There was no difference between the 2 groups (p=0.315) when analyzing for life-threatening arrhythmia.
Conclusion
Pimobendan might safely contributes to prolonging the period until re-hospitalization in Japanese patients with advanced heart failure, especially in the post-discharge vulnerable phase.

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