Emerging drug therapies for the management of acute decompensated heart failure

The mortality and morbidity of patients with heart failure (HF) remains unacceptably high despite current advances in medical therapies. In recent years, rapid growth in understanding the pathophysiology of heart failure has allowed for insights into many potential new therapeutic strategies. Yet until now, despite sound biological basis for efficacy and success in early-phase studies, novel agents have not stood up to the scrutiny of late-phase clinical trials. This review will examine the key emerging therapies for acute decompensated heart failure (ADHF), in light of available pathophysiological and clinical evidence. Several new agents for ADHF use novel mechanisms of action that focus on new treatment targets, such as those providing anti-ischemic and anti-stunning effects, blocking vasopressin receptors, blocking endothelin-1 receptors, or endogenous cardiac neurohormones and B-type natriuretic peptide (BNP).