INTRODUCTION: We investigated the factors associated with readmission in patients with congestive heart failure (HF) receiving long-term administration of tolvaptan (TLV) to support treatment decisions for HF. METHODS: This retrospective cohort study included 181 patients with congestive HF who received long-term administration of TLV. Long-term administration of TLV was defined as the administration of TLV for 60 days or longer. The outcome was a readmission event for worsening HF within 1 year after discharge. Significant factors associated with readmission were selected using multivariate analysis. To compare the time to readmission using significant factors extracted in a multivariate analysis, readmission curves were constructed using the Kaplan-Meier method and analysed using the log-rank test. RESULTS: The median age was 78 years (range, 38-96 years), 117 patients (64.6%) were males, and 77 patients (42.5%) had a hospitalisation history of HF. Readmission for worsening HF within 1 year after long-term TLV treatment occurred in 62 patients (34.3%). In the multivariate analysis, estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m 2 (odds ratio, 3.22; 95% confidence interval, 1.661-6.249; P = 0.001) was an independent significant factor. When eGFR at discharge was divided into two groups (eGFR < 30 vs. eGFR ≥ 30), readmission rates within 1 year were 53.3% vs. 25.4%, respectively ( P = 0.001). CONCLUSION We revealed that eGFR was strongly associated with readmission in patients with HF who received long-term administration of TLV. Furthermore, we showed that eGFR is an important indicator in guiding treatment of HF in patients receiving TLV.
Humans ; Tolvaptan/therapeutic use* ; Heart Failure/drug therapy* ; Male ; Female ; Patient Readmission/statistics & numerical data* ; Aged ; Retrospective Studies ; Aged, 80 and over ; Middle Aged ; Glomerular Filtration Rate ; Adult ; Antidiuretic Hormone Receptor Antagonists/therapeutic use* ; Risk Factors ; Kaplan-Meier Estimate ; Multivariate Analysis

Walking is the most basic movement in daily life, and is a popular exercise for eloerly individuals to keep their health. However, it is not clear how walking is effective in keeping or increasing the muscle mass and bone intensity of the lower limbs. This study aimed to investigate the relationships between walking steps per day during daily life and either the muscle thickness values of lower leg anterior and posterior or the bone intensity of calcaneus. The subjects were 116 healthy men (n=31) and women (n=85) aged from 60 to 78 yrs, Walking steps per day were deter-mined using a pedometer. Muscle thickness values at the lower leg anterior and posterior sites and the osteo sono assessment index (OSI) of calcaneus were determined using ultrasonographic apparatuses. In women, OSI correlated significantly with walking steps (r=0.265, p<0.05) and the product of walking steps and weight (r=0.369, p<0.05) . In both genders, however, no significant correlations were found between walking steps and muscle thickness values at the two sites. The findings here suggest that increasing the number of walking steps during daily life will improve the intensity of calcaneus for elderly women, but is not effective for inducing hypertrophic change in the muscles located in the lower limbs for elderly individuals of both genders.