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Clinical utility of early use of tolvaptan in very elderly patients with acute decompensated heart failure.

Clinical utility of early use of tolvaptan in very elderly patients with acute decompensated heart failure.
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Niikura H, Iijima R, Anzai H, Kogame N, Fukui R, Takenaka H, Kobayashi N,


Niikura H, Iijima R, Anzai H, Kogame N, Fukui R, Takenaka H, Kobayashi N, (click to view)

Niikura H, Iijima R, Anzai H, Kogame N, Fukui R, Takenaka H, Kobayashi N,

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Anatolian journal of cardiology 2017 08 02() doi 10.14744/AnatolJCardiol.2017.7628
Abstract
OBJECTIVE
The establishment of an optimal strategy for elderly patients with acute decompensated heart failure (ADHF) is currently an important issue. Particularly in very elderly (VE) patients, ADHF is associated with a poor prognosis. We therefore aimed to evaluate the efficacy and safety of the early use of tolvaptan (TLV) in VE patients.

METHODS
Of 245 patients with ADHF admitted between March 2013 and July 2014, we prospectively enrolled 111 patients with TLV first administered within 24 h of hospitalization. These were divided into two groups according to the age: VE (≥85 years, n=45) and not very elderly (NVE, <85 years, n=66). The endpoints were the incidence of worsening renal function, death by any cause, or the length of hospital stay. RESULTS
There were no significant differences between the two groups in the incidence of worsening renal function (26.7% in VE vs. 25.8% in not VE, p=0.92), dose of TLV after hospitalization (7.4±0.7 vs. 7.5±1.3 mg/day, p=0.63), mean duration of the use of TLV (4.3±3.5 vs. 5.4±4.8 days, p=0.17), or mean length of hospital stay (16.5±7.8 vs. 15.7±8.0 days, p=0.64).

CONCLUSION
TLV shows similar efficacy and safety in both VE and NVE groups. Even for VE patients with ADHF, initiation of TLV with standard diuretic treatment may have the potential not to increase the incidence of worsening renal function.

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