Key result
Among patients receiving long-term tolvaptan therapy, heart failure with preserved ejection fraction was associated with a significantly lower risk of all-cause mortality compared to reduced ejection fraction (HR 0.44).
Why the study?
Few studies had investigated the clinical benefit of the long-term use of tolvaptan for heart failure across patients with HFpEF versus HFrEF.
Does long-term tolvaptan administration result in different all-cause mortality outcomes in patients with HFpEF compared to HFrEF?
Cohort (n=147)
No
Does long-term tolvaptan administration result in different all-cause mortality outcomes in patients with HFpEF compared to HFrEF?
Long-term administration of tolvaptan for more than 1 year is associated with significantly lower all-cause mortality in patients with HFpEF compared to those with HFrEF.
HFpEF on long-term tolvaptan linked to lower mortality than HFrEF; hypothesis-generating and requires randomized confirmation before practice change.
Few studies have investigated the clinical benefit of the long-term use of tolvaptan (TLV) for heart failure (HF). This study evaluated the long-term prognosis of patients administered TLV for > 1 year among patients who had HF with preserved ejection fraction (HFpEF) and those who had HF with reduced ejection fraction (HFrEF). Overall, 591 consecutive patients were admitted to our hospital and administered TLV for HF between 2011 and 2018. We retrospectively enrolled 147 patients who were administered TLV for > 1 year. We divided them into the HFpEF group (n = 77, 52.4%) and the HFrEF group (n = 70; 47.6%). Their clinical backgrounds and long-term prognosis were examined. Compared with the patients in the HFrEF group, the patients in the HFpEF group were significantly older and included more women. Moreover, the HFpEF group showed significantly lower all-cause mortality (38.6% vs. 24.7%; log-rank, P = 0.014) and cardiovascular mortality during the average 2.7-year follow-up. Univariate analysis revealed that all-cause mortality was correlated with male sex, HFpEF, and changes in serum creatinine levels from baseline. Multivariate analysis revealed that HFpEF was an independent influencing factor for all-cause mortality (hazard ratio, 0.44; 95% confidence interval, 0.23-0.86; P = 0.017). Long-term administration of TLV may be more beneficial for HFpEF than for HFrEF.
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Seki et al. (2021) conducted a cohort in Congestive heart failure (n=147). Heart failure with preserved ejection fraction (HFpEF) vs. Heart failure with reduced ejection fraction (HFrEF) was evaluated on All-cause mortality (HR 0.44, 95% CI 0.23-0.86, p=0.017). Among patients receiving long-term tolvaptan therapy, heart failure with preserved ejection fraction was associated with a significantly lower risk of all-cause mortality compared to reduced ejection fraction (HR 0.44).
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