Pharmacologic therapy for acute heart failure

Acute heart failure syndrome (AHFS) is prevalent and costly, and clinical development of pharmacologic therapy remains challenging. Relieving congestion is still the central goal in the decompensated states, although the predominant approach remains the use of intravenous loop diuretics. Newer agents such as vasopressin receptor antagonists have yet to show incremental benefits. A resurgence of interest in vasodilator therapy has been supported by a better understanding of the pathophysiology of AHFS and the availability of nesiritide and other natriuretic peptides, but long-term clinical outcomes data are lacking and highly debated. Several promising drugs are currently undergoing clinical development for the treatment of AHFS, although many of the clinical challenges remain unresolved.