Predictors of clinical outcome in heart failure patients treated with vasopressin type 2 receptor antagonist

Objectives: There are well-established risk prediction models of in-hospital mortality due to heart failure (HF). However, the predictors of mortality during acute hospitalization in individuals with HF receiving tolvaptan, a vasopressin type 2 receptor antagonist, are poorly understood. Methods: Sixty-one hospitalized patients prescribed tolvaptan to treat worsening HF were consecutively enrolled in this study. The study endpoint was death during hospitalization. Results: Compared with survivors, patients who died in hospital had higher Get With The Guidelines-Heart Failure (GWTG-HF) risk scores, decreased albumin levels, increased serum creatinine levels, smaller inferior vena cava (IVC) diameters on echocardiography, and were more likely to have received catecholamine infusion. A multivariate logistic regression analysis revealed that in addition to GWTG-HF risk score >47, albumin level ≤2.4 g/dL, creatinine level >1.5 mg/dL, IVC diameter ≤15 mm, and catecholamine infusion were all novel and significant predictors of in-hospital death. Moreover, combining these novel predictors to the GWTG-HF risk score significantly improved prediction of in-hospital death, as shown by the greater area under the receiver operating characteristic (ROC) curve. Conclusions: In patients with worsening HF receiving oral tolvaptan, we identified novel predictors of in-hospital death. Our findings may be helpful in developing novel treatment strategies for patients receiving tolvaptan for HF in clinical settings.