Current and emerging pharmacologic options for the management of patients with chronic and acute decompensated heart failure

ABSTRACT

Introduction: For many years heart failure (HF) was known as a fatal disease with an ominous prognosis. In the last decades better understanding of the pathophysiological mechanisms underlying HF has resulted in major breakthrough in the management and improvement in the natural history of this clinical syndrome.

Areas covered: The review is focused on current and upcoming pharmacological therapies in patients with chronic and acute HF, starting with brief overview of drugs which improve the outcomes in patients with chronic HF with reduced ejection fraction (EF) including neurohormonal antagonists, angiotensin receptor neprilysin inhibitor and If- channel inhibitor, then presenting the summary of symptomatic treatment, the pharmacotherapy in chronic HF with preserved and mid-range EF and in acute HF. Finally, we report the emerging pharmacologic options and ongoing clinical trials and future directions in pharmacotherapy.

Expert commentary: The guidelines-recommended therapies in HF with reduced EF need to be widely implemented into the everyday clinical practice. Better clinical characterization of HF with preserved, mid-range EF and acute HF, with better understanding of the underlying pathophysiological mechanisms may ultimately result in a development of effective strategies improving ominous outcomes in these patients.

KEYWORDS:

• Heart failure management
• heart failure pharmacotherapy
• angiotensin-converting enzyme inhibitors
• beta-blockers
• mineralocorticoid receptor antagonists
• angiotensin receptor neprilysin inhibitor
• If- channel inhibitor
• diuretics

Declaration of interest

P Ponikowski received consulting fees from: Amgen, Bayer, Berlin-Chemie, Cardiorentis, Johnson&Johnson, Merck, Novartis, Servier, Trevena, Vifor Pharma and research support from: Servier, Vifor Pharma. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was not funded.