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Treatment of congestive heart failure a neuroendocrine disorder
1Veterinary Cardiorespiratory Centre, Thera House, Waverley Road, Kenilworth, Warwickshire CV8 1JL.
Insights
Heart failure treatment now targets neuroendocrine systems, not just pump function. This review examines drugs for human and veterinary heart failure, focusing on evidence from randomized trials.
Area of Science:
- Cardiology
- Pharmacology
- Veterinary Medicine
Background:
- Heart failure understanding has evolved from a pump failure model to recognizing complex neuroendocrine system activation.
- Current treatment aims to modulate detrimental neuroendocrine systems and mitigate myocardial maladaptation.
Purpose of the Study:
- To review the neuroendocrine systems implicated in heart failure.
- To discuss available drug treatments in human and veterinary medicine for heart failure.
- To focus on evidence from high-quality randomized trials.
Main Methods:
- Literature review of scientific articles and randomized controlled trials.
- Analysis of neuroendocrine pathways involved in heart failure pathophysiology.
- Comparison of drug therapies used in human and veterinary cardiology.
Main Results:
- Angiotensin converting enzyme inhibitors are the sole licensed veterinary drugs directly impacting heart failure neurohormones.
- A broader range of drugs is available in human medicine, with some gaining use in veterinary cardiology.
- Evidence from randomized trials guides treatment strategies in both fields.
Conclusions:
- Modulating neuroendocrine systems is crucial for managing heart failure.
- Veterinary cardiology can benefit from human medicine's expanded therapeutic options.
- Evidence-based practice using randomized trial data is essential for effective heart failure treatment.
Abstract:
The understanding of heart failure is no longer based on a supply and demand model of pump failure. Rather, heart failure is seen as a complex pathophysiological process with activation of various neuroendocrine systems. The goals of treatment have changed towards modifying these counterproductive neuroendocrine systems and slowing myocardial maladaptation. Angiotensin converting enzyme inhibitors are the only licensed drugs in veterinary practice that have a direct effect on neurohormones in heart failure. The range of drug options in human medicine is greater and some of these drugs are also increasingly being used in veterinary cardiology practice. This review describes the neuroendocrine systems involved in heart failure and discusses the range of drugs available in human and veterinary medicine. In doing so, it concentrates on the evidence available from good quality randomised trials in both the veterinary field and, where relevant, the human medical field.