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Heart Failure Medication Provides Some Symptom Relief

A medication used to treat heart failure, tolvaptan, appears to improve some symptoms and signs of heart failure during hospitalization//, but does not reduce the risk of re-hospitalization or death, according to two articles in the issue of JAMA. The study is being released early to coincide with its presentation at the American College of Cardiology's annual conference.

During the past 2 decades, there have been substantial advances in drug therapy for chronic heart failure (HF), but the number of annual hospitalizations for HF continues to increase, and the risk of death remains high among patients hospitalized with HF, according to background information in the first article. "To date, no treatment initiated at the time of hospitalization for acute decompensated [characterized by severe symptoms and signs] HF has been found to improve clinical outcomes. In fact, in randomized controlled trials of such treatments, the observed clinical benefits have been marginal at best, and concern has been raised about the adverse effect of these treatments on long-term clinical outcomes."

Marvin A. Konstam, M.D., of Tufts - New England Medical Center, Boston, and colleagues with the Efficacy of Vasopressin Antagonism in Heart Failure: Outcome Study With Tolvaptan (EVEREST) trial, examined the long-term clinical outcomes of the heart failure medication tolvaptan. The trial, comprised of two short-term clinical status studies, included 4,133 patients hospitalized with heart failure at 359 North American, South American, and European sites between October 2003 and February 2006, and followed up during long-term treatment. Within 48 hours of hospital admission, the patients were randomly assigned to receive oral tolvaptan, 30 mg once per day (n = 2,072), or placebo (n = 2,061) for a minimum of 60 days, in addition to standard therapy.

The researchers found that during a median (midpoint) follow-up of 9.9 months, 25.9 percent of patients in the
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