O56-5 - Predictors of Long-term Tolvaptan Necessity in Outpatients with Decompensated Heart Failure

Background: Recent clinical trials have demonstrated the efficacy of short-term treatment with tolvaptan (TLV), a novel vasopressin V2 receptor antagonist, in hospitalized patients with decompensated heart failure (HF). However, there have been no studies on the patients' characteristics who cannot withdraw TLV administration safely in long-term follow up period. Methods and Results: We retrospectively analyzed consecutive 45 outpatients with HF who started TLV and continued for >3 months and were followed for >6 months. Among 45 patients, 20 patients could withdraw TLV safely (Group A; GA) and 25 patients could not, or had to restart (Group B; GB). In both groups, the total urine output within 7 days after the first administration of TLV, plasma BNP level, etiology of HF, LVEF and NYHA class were comparable. In contrast, patients in GB had significantly more frequent history of HF hospitalization (48% vs 10%; P = .0062) and higher rate of prior usage of loop diuretics (76% vs 30%; P = .002) compared to GA. Furthermore, patients in GB had higher levels of serum creatinine (1.61 ± 0.76 vs 0.99 ± 0.29; P = .0012) and increased incidence of in-hospital worsening renal function (WRF; 28% vs 5%; P = .0497) compared to GA. Conclusions: History of hospitalization due to HF, prior usage of loop diuretics, renal insufficiency on admission, and in-hospital WRF predicts the long-term necessity of TLV administration for treatment of HF.