Key result
In acute heart failure patients treated with tolvaptan, efficacy and safety were comparable between those aged ≥90 years and <90 years, with no significant difference in worsening renal function (20% vs 28%; P=0.48).
Why the study?
Tolvaptan causes aquaresis and improves symptoms in congestive heart failure, but few studies have explored its effect in acute heart failure patients aged 90 years or older.
Does tolvaptan have comparable efficacy and safety in acute heart failure patients ≥90 years old compared to those <90 years old?
Cohort (n=106)
Does tolvaptan have comparable efficacy and safety in acute heart failure patients ≥90 years old compared to those <90 years old?
Absolute Event Rate: 20% vs 28%
p-value: p=0.48
Tolvaptan demonstrates comparable efficacy and safety in acute heart failure patients aged over 90 years compared to younger patients, supporting its use in this very elderly population.
Supports tolvaptan consideration in ≥90-year-olds with acute HF; hypothesis-generating, requires randomized confirmation.
Background: The oral vasopressin-2 receptor antagonist, tolvaptan, causes aquaresis and improves symptoms in patients with congestive heart failure. However, few studies have explored the effect of tolvaptan in acute heart failure (AHF) patients ≥90 years old. Methods: This study enrolled 106 AHF patients treated with tolvaptan added to standard therapy. The subjects were divided into 2 groups: ≥90-year-old patients (over-90 group, mean 92 ± 2 years, n = 45) and <90-year-old patients (under-90 group, mean 76 ± 11 years, n = 61). Patients’ characteristics were assessed, and efficacy and safety were compared between the 2 groups. Results: The over-90 group had a lower proportion of male patients, lower body weight, and higher ejection fraction. The under-90 group had significantly higher prevalence of ischemic heart disease and diabetes mellitus. There were no significant differences between the 2 groups in total urine volume at 24 and 48 hours (1934 ± 983 mL vs 1816 ± 1028 mL, P = 0.58 and 3806 ± 1444 mL vs 4078 ± 1851 mL, P=0.47, respectively), the mean change in body weight (−3.0 ± 2.7 kg vs −2.6 ± 2.6 kg, P = 0.50), improvement of congestive symptoms, changes in serum sodium and creatinine levels, the incidences of hypernatremia (n = 0, 0% vs n = 1, 1.6%, P = 0.63), and worsening renal function (n = 9, 20% vs n = 17, 28%, P = 0.48). Conclusion: The efficacy and safety of tolvaptan in AHF patients aged more than 90 years were comparable to those of <90 years old. Tolvaptan provides a complementary therapeutic option for AHF patients aged more than 90 years.
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Sato et al. (2019) conducted a cohort in Acute heart failure (n=106). Age ≥90 years vs. Age <90 years was evaluated on worsening renal function (p=0.48). In acute heart failure patients treated with tolvaptan, efficacy and safety were comparable between those aged ≥90 years and <90 years, with no significant difference in worsening renal function (20% vs 28%; P=0.48).
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