Efficacy of Tolvaptan in Acute Decompensated Heart Failure (ADHF) : A single centre experience
Tóm tắt
Background
Heart Failure (HF) remains an important cause of hospitalisation accounting for 6%-10% of all acute medical admissions in Malaysia. Traditionally used loop diuretics for volume decongestion often leads to electrolyte imbalance. Tolvaptan an orally active vasopressin V2- receptor antagonist that promotes aquaresis might be of benefit in achieving early euvolemia without electrolyte imbalance. This study is to determine the efficacy of Tolvaptan in volume decongestion in hospitalised HF and its effect on the electrolytes and renal profile (RP).
Methods
This is a retrospective cohort study of all hospitalized heart failure patients prescribed with Tolvaptan in the National Heart Institute, a tertiary heart centre in Malaysia between 1st February 2023 till 31st July 2023. Patients were randomly selected and started on tolvaptan. The demographic characteristics, mean change in urine output, body weight and RP were recorded and further analysed.
Results
There was a total of 589 admissions for acute decompensated heart failure (ADHF) between the study period in which 14 patients (50% Malay, 36 % Chinese, 7% Indian, 7% others) were randomly selected and started on tolvaptan, where all of them were given loop diuretics frusemide concomitantly. They were of mean age of 62.5 ± 7.6 years, predominantly male (6:1) with mean a left ventricular ejection fraction (LVEF) of 30.2 ± 14.5%. Mean treatment duration was 4.9 ± 2.6 days. Patients started on tolvaptan had a mean weight reduction of 3.95 ± 0.9 kg. Tolvaptan treatment also increases urine output by 72.6% with a mean urine output of 2.2 ± 1.0L per day. Up to 78.6% have their sodium and 85.7% have their potassium within normal laboratory range throughout treatment period (p<0.05), and 71.4% patients’ RP maintains normal after started on treatment, while only 21.4% had their creatinine worsened by 14.4-39.3% (p=0-89). One patient (7%) had his creatinine improved by 49.7%.
Conclusion
Tolvaptan has showed a favourable result in effective volume decongestion in acute setting safely without causing electrolyte derangement or compromising renal function in this study
