In an accompanying editorial, Clyde W. Yancy, M.D., of the Baylor University Medical Center, Dallas, examines the findings of the EVEREST trial.
"In the context of acute decompensated heart failure (ADHF), these are noteworthy findings. To date, no other therapeutic intervention has been demonstrated in large-scale randomized, placebo-controlled studies to positively influence symptoms in ADHF without generating a question of harm," he writes. "Taken together, these findings would suggest some short-term benefit of tolvaptan on certain acute symptoms of ADHF without evidence of harm and represent an important contribution for understanding the management of patients with ADHF."
"However, use of tolvaptan must be carefully considered, as evidence of long-term benefit is lacking. Moreover, given the characteristics of the patient cohort in EVEREST, the use of tolvaptan should not be extrapolated to patients who are dissimilar," Dr. Yancy writes. "As additional reports from EVEREST and from new clinical trials with both medical and device therapies become available, the hope is that progress toward reaching additional evidence-based therapies on the mountain of acute decompensated heart failure will continue."-JAMA and Archives Journals
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