Climbing the Mountain of Acute Decompensated Heart Failure

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Abstract
In this issue of JAMA, 2 articles report findings from the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study With Tolvaptan (EVEREST) clinical trials program. Konstam et al1 report the overall long-term effects of tolvaptan in terms of safety and clinical outcomes for patients with worsening heart failure (HF) requiring hospitalization. Gheorghiade et al2 report short-term effects of tolvaptan for acute symptom relief in these same patients, but presented as 2 trials that were based on study center assignment following completion of patient enrollment and randomization in the long-term trial. The aggregate findings demonstrate that tolvaptan relieves some symptoms associated with acute decompensated heart failure (ADHF) and has no demonstrable evidence of harm such as worsening of renal failure, but importantly, does not reduce mortality or HF-related morbidity at 1 year.

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