Heart failure.

Area of Science:

• Cardiology
• Public Health
• Pharmacology

Background:

• Heart failure (HF) persists as a major public health issue despite therapeutic advances, characterized by high prevalence, adverse clinical outcomes, and substantial healthcare costs.
• Established risk factors for HF are well-understood, suggesting that preventive strategies could significantly reduce disease burden.
• Current management of chronic systolic HF involves neurohormonal blockade (renin-angiotensin-aldosterone and sympathetic nervous systems) to mitigate adverse cardiac remodeling, alleviate symptoms, and improve survival.

Purpose of the Study:

• To review current management strategies for heart failure, encompassing pharmacological and device-based therapies.
• To highlight the limitations in evidence for treating acute HF and HF with preserved ejection fraction.
• To explore emerging strategies for personalized HF management, including novel diagnostic tools, therapeutic targets, and regenerative medicine approaches.

Main Methods:

• Review of established and emerging treatments for heart failure.
• Analysis of current guidelines for managing chronic systolic heart failure, acute heart failure, and heart failure with preserved ejection fraction.
• Exploration of novel therapeutic avenues, including regenerative medicine and personalized treatment approaches.

Main Results:

• Standard treatments for chronic systolic HF include neurohormonal antagonists and diuretics, alongside device therapies like cardiac resynchronization and defibrillator implantation for advanced cases.
• Clinical evidence supporting treatments for acute HF and HF with preserved ejection fraction remains limited.
• Emerging strategies focus on personalized treatment, advanced diagnostics, novel pharmacological targets, and regenerative therapies such as cell-based and gene-based methods.

Conclusions:

• Despite progress, heart failure remains a critical public health challenge requiring multifaceted management strategies.
• Current evidence gaps necessitate further research, particularly for acute HF and HF with preserved ejection fraction.
• Future directions in heart failure management involve personalized medicine, innovative diagnostics, and regenerative approaches for cardiac repair.