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Nakao Y, Kawakami H, Saito M, Inoue K, Ikeda S, Yamaguchi O. Cost-Effectiveness of long-term tolvaptan administration for chronic heart failure treatment in Japan. J Cardiol 2021; 79:408-416. [PMID: 34799217 DOI: 10.1016/j.jjcc.2021.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/24/2021] [Accepted: 10/04/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Tolvaptan (TLV) is effective for acute heart failure (HF) with congestion, but its long-term administration in patients with chronic HF (CHF) remains controversial. Moreover, the cost-effectiveness of TLV for CHF treatment has not yet been investigated. Thus, we sought to validate the cost-effectiveness of TLV for CHF treatment in Japan. METHODS A Markov model was developed to compare total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER) between long-term TLV strategy and the standard strategy using furosemide for CHF. The target population included 75-year-old patients with CHF. The effectiveness of the TLV strategy for CHF treatment was determined based on a systematic review and meta-analysis. We used a 10-year horizon, with sensitivity analyses for significant variables and a scenario analysis for patients with CHF receiving high-dose furosemide (≥60 mg per day). RESULTS In the base case analysis, the total cost of the long-term TLV strategy was higher than that of the standard strategy (\3,243,779 vs. \1,179,964). The total QALYs of the long-term TLV strategy were lower than those of the standard strategy (4.52 vs 4.59). Thus, a standard TLV prescription for CHF treatment has no clinical or economic benefit. In the scenario analysis (i.e. in patients with CHF receiving high-dose furosemide), the long-term TLV strategy was more effective (total QALYs, 5.10 vs. 4.41) but more expensive (total costs, \3,540,558 vs. \1,272,208) than the standard strategy. The ICER of the TLV strategy against the standard strategy (¥3,289,579/QALY) was below the willingness-to-pay of \5,000,000, which suggests that the long-term TLV strategy is cost-effective relative to the standard strategy in patients with CHF receiving high-dose furosemide. CONCLUSIONS Long-term TLV administration did not provide a clear benefit for all patients with CHF. However, this treatment strategy may be a cost-effective therapeutic option for patients who require high-dose furosemide.
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Affiliation(s)
- Yasuhisa Nakao
- Department of Cardiology, Pulmonology, Nephrology and Hypertension, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Hiroshi Kawakami
- Department of Cardiology, Pulmonology, Nephrology and Hypertension, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan.
| | - Makoto Saito
- Department of Cardiology, Kitaishikai Hospital, Ozu, Japan
| | - Katsuji Inoue
- Department of Cardiology, Pulmonology, Nephrology and Hypertension, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Shuntaro Ikeda
- Department of Cardiology, Pulmonology, Nephrology and Hypertension, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Osamu Yamaguchi
- Department of Cardiology, Pulmonology, Nephrology and Hypertension, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
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Tanaka N, Dan K, Maeda T, Ishihara H, Teramura M, Ichihashi K, Takahashi Y, Tsuzura D, Shinoda A, Fujii M, Okada H, Teramoto T. Clinical Effects of Early and Short-Term Tolvaptan Administration in Patients Hospitalized for Acute Decompensated Heart Failure. Cardiology 2021; 146:739-747. [PMID: 34348260 DOI: 10.1159/000518732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 07/24/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Nobukiyo Tanaka
- Department of Cardiovascular Medicine, Ichinomiya Nishi Hospital, Ichinomiya, Japan
| | - Kazuhiro Dan
- Department of Cardiovascular Medicine, Ichinomiya Nishi Hospital, Ichinomiya, Japan
| | - Takuya Maeda
- Department of Cardiovascular Medicine, Ichinomiya Nishi Hospital, Ichinomiya, Japan
| | - Hiroki Ishihara
- Department of Cardiovascular Medicine, Ichinomiya Nishi Hospital, Ichinomiya, Japan
| | - Masanori Teramura
- Department of Cardiovascular Medicine, Ichinomiya Nishi Hospital, Ichinomiya, Japan
| | - Kei Ichihashi
- Department of Cardiovascular Medicine, Ichinomiya Nishi Hospital, Ichinomiya, Japan
| | - Yuya Takahashi
- Department of Cardiovascular Medicine, Ichinomiya Nishi Hospital, Ichinomiya, Japan
| | - Daichi Tsuzura
- Department of Cardiovascular Medicine, Ichinomiya Nishi Hospital, Ichinomiya, Japan
| | - Akira Shinoda
- Department of Cardiovascular Medicine, Ichinomiya Nishi Hospital, Ichinomiya, Japan
| | - Masato Fujii
- Department of Cardiovascular Medicine, Ichinomiya Nishi Hospital, Ichinomiya, Japan
| | - Hisashi Okada
- Department of Cardiovascular Medicine, Ichinomiya Nishi Hospital, Ichinomiya, Japan
| | - Tomohiko Teramoto
- Department of Cardiovascular Medicine, Ichinomiya Nishi Hospital, Ichinomiya, Japan
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Takikawa T, Sumi T, Takahara K, Ohguchi S, Oguri M, Ishii H, Murohara T. <Editors' Choice> Prognostic utility of multipoint nutritional screening for hospitalized patients with acute decompensated heart failure. NAGOYA JOURNAL OF MEDICAL SCIENCE 2021; 83:93-105. [PMID: 33727741 PMCID: PMC7938087 DOI: 10.18999/nagjms.83.1.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 07/22/2020] [Indexed: 11/30/2022]
Abstract
This study aimed to evaluate the impact of serial changes in nutritional status on 1-year events including all-cause mortality or rehospitalization owing to heart failure (HF) among hospitalized patients with acute decompensated HF (ADHF). The study subjects comprised 253 hospitalized patients with ADHF. The controlling nutritional status (CONUT) score was assessed both at hospital admission and discharge. The subjects were divided into three groups according to nutritional status using CONUT score: normal (0 and 1), mild risk (2-4), and moderate to severe risk defined as malnutrition (5-12). We observed nutritional status was improved or not. The incidence of malnutrition was 30.4% at hospital admission and 23.7% at discharge, respectively. Malnutrition was independently associated with 1-year events among hospitalized patients with ADHF. Presence or absence of improvement in nutritional status was significantly associated with 1-year events (P < 0.05), that was independent of percentage change in plasma volume in multivariate Cox regression analyses. We determined a reference model, including gender and estimated glomerular filtration rate, using multivariate logistic regression analysis (P < 0.05). Adding the absence of improvement in nutritional status during hospitalization to the reference model significantly improved both NRI and IDI (0.563, P < 0.001 and 0.039, P = 0.001). Furthermore, malnutrition at hospital discharge significantly improved NRI (0.256, P = 0.036) In conclusion, serial changes in the nutritional status evaluated on the basis of multiple measurements may provide more useful information to predict 1-year events than single measurement at hospital admission or discharge in hospitalized patients with ADHF.
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Affiliation(s)
- Tomonobu Takikawa
- Department of Cardiology, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Takuya Sumi
- Department of cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Kunihiko Takahara
- Department of Cardiology, Kasugai Municipal Hospital, Kasugai, Japan
| | - Shiou Ohguchi
- Department of Cardiology, Kasugai Municipal Hospital, Kasugai, Japan
| | - Mitsutoshi Oguri
- Department of Cardiology, Kasugai Municipal Hospital, Kasugai, Japan
| | - Hideki Ishii
- Department of Cardiology, Graduate School of Medicine, Nagoya University, Nagoya, Japan
- Department of Cardiology, Department of Cardiology, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Graduate School of Medicine, Nagoya University, Nagoya, Japan
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4
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Wang L, Zhang Q, Liu M, Chen S, Han S, Li J, Du R. Tolvaptan in reversing worsening acute heart failure: A systematic review and meta-analysis. J Int Med Res 2019; 47:5414-5425. [PMID: 31680601 PMCID: PMC6862870 DOI: 10.1177/0300060519882221] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective In this meta-analysis, we aimed to compare efficacy and clinical outcomes of tolvaptan in treating acute heart failure (AHF). Methods Using MEDLINE, we searched relevant clinical studies using tolvaptan that investigated clinical effects in treating AHF. We performed meta-analysis for potentially extractable clinical outcomes such as body weight reduction, change in serum sodium levels, and clinical or safety events including worsening heart failure, worsening renal function (WRF), all-cause mortality, rehospitalization, and dyspnea improvement. Results The results showed that tolvaptan significantly reduced body weight (mean change: −1.28 kg, 95% credible interval (CI): −1.58–0.98), increased serum sodium levels (mean change: 3.48 mmol/L; 95% Cl: 3.22–3.74), and improved dyspnea function (odds ratio (OR): 1.43; 95% CI: 1.26–1.62) versus conventional therapy. The event risk of WRF was also significantly reduced (OR: 0.35; 95% CI: 0.15–0.80). Low, intermediate, and high tolvaptan doses did not reduce mortality and rehospitalization risks. No significant publication bias was observed regarding effects on mortality and rehospitalization. Conclusion Current evidence indicates that using tolvaptan as add-on therapy can decrease body weight, increase sodium levels, improve dyspnea function, and reverse WRF, which may circumvent loop diuretics overdose and improve outcomes in patients with AHF.
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Affiliation(s)
- Lili Wang
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, Hebei Province, China
| | - Qianhui Zhang
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, Hebei Province, China
| | - Meixia Liu
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, Hebei Province, China
| | - Shuxia Chen
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, Hebei Province, China
| | - Shuang Han
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, Hebei Province, China
| | - Jing Li
- Department of Hematology, Hebei Province Hospital of Chinese Medicine, Shijiazhuang, Hebei Province, China
| | - Rongpin Du
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, Hebei Province, China
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Sato Y, Uzui H, Mukai M, Shiomi Y, Hasegawa K, Ikeda H, Tama N, Fukuoka Y, Morishita T, Ishida K, Kaseno K, Miyazaki S, Nakano A, Tada H. Efficacy and Safety of Tolvaptan in Patients More Than 90 Years Old With Acute Heart Failure. J Cardiovasc Pharmacol Ther 2019; 25:47-56. [PMID: 31280620 DOI: 10.1177/1074248419861962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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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Affiliation(s)
- Yusuke Sato
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.,Depatment of Cardiology, Hikone Municipal Hospital, Shiga, Japan
| | - Hiroyasu Uzui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Moe Mukai
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.,Depatment of Cardiology, Hikone Municipal Hospital, Shiga, Japan
| | - Yuichiro Shiomi
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Kanae Hasegawa
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Hiroyuki Ikeda
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Naoto Tama
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Yoshitomo Fukuoka
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Tetsuji Morishita
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Kentaro Ishida
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Kenichi Kaseno
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Akira Nakano
- Depatment of Cardiology, Hikone Municipal Hospital, Shiga, Japan
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
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Kiuchi S, Hisatake S, Kabuki T, Oka T, Dobashi S, Fujii T, Ikeda T. Comparable effect of tolvaptan in heart failure patients with preserved or reduced ejection fraction. Clin Exp Hypertens 2019; 42:110-117. [PMID: 30793983 DOI: 10.1080/10641963.2019.1583244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: It is unclear that the difference in efficacy of tolvaptan (TLV) on the length of hospital stay for both heart failure (HF) preserved ejection fraction (EF) (HFpEF) and reduced EF (HFrEF) patients.Methods: We investigated 369 patients who were hospitalized with HF from February 2011 to June 2016 and initiated TLV. Patients who died in hospital, transferred hospital or clinical scenario 4 or 5 were excluded. Finally, we analyzed 108 patients with HFpEF and 96 patients with HFrEF. We evaluated the relationship between the length of hospital stay and the date of TLV initiation. Moreover, we compared the early use (within the median) and delayed use (the median or later) of TLV.Results: The date of TLV initiation was statistically associated with the length of hospital stay in both HFpEF and HFrEF (HFpEF: r = 0.625, P < 0.001, HFrEF: r = 0.618, P < 0.001). In HFpEF, the length of hospital stay in delayed use group was significantly longer than the early use group (22.2 ± 10.7 days and 38.1 ± 22.6 days, P < 0.001). The result was similar in HFrEF (22.0 ± 15.0 days and 32.1 ± 22.0 days, P = 0.008). On the other hand, there were no statistically significant differences in the length of hospital stay after initiation of TLV in both HFpEF and HFrEF. Other findings (including the severity of HF) were similar between the early use group and the delayed group in HFpEF and HFrEF.Conclusions: The time until TLV initiation after hospitalization was related to the length of hospital stay in HFpEF and HFrEF patients.
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Affiliation(s)
- Shunsuke Kiuchi
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Shinji Hisatake
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Takayuki Kabuki
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Takashi Oka
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Shintaro Dobashi
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Takahiro Fujii
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
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Otsuka K, Shimada K, Katayama H, Nakamura H, Ishikawa H, Takeda H, Fujimoto K, Kasayuki N, Yoshiyama M. Prognostic significance of renal dysfunction and its change pattern on outcomes in patients with acute coronary syndrome treated with emergent percutaneous coronary intervention. Heart Vessels 2018; 34:735-744. [DOI: 10.1007/s00380-018-1291-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 10/26/2018] [Indexed: 10/28/2022]
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