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Heart failure

Marco Metra1, John R Teerlink2

  • 1Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.

Lancet (London, England)
|May 3, 2017
PubMed

Insights

Heart failure treatments are improving, with new drugs like angiotensin receptor neprilysin inhibitors (ARNIs) showing promise. However, effective therapies for heart failure with preserved ejection fraction remain elusive, highlighting an unmet clinical need.

Area of Science:

  • Cardiology
  • Internal Medicine

Background:

  • Heart failure (HF) is a global health concern with increasing prevalence due to population aging and improved acute cardiovascular event management.
  • While therapies exist for heart failure with reduced ejection fraction (HFrEF), such as ACE inhibitors, ARBs, beta-blockers, and ARNIs, significant unmet needs persist, particularly for heart failure with preserved ejection fraction (HFpEF).

Purpose of the Study:

  • To review current therapeutic strategies for heart failure, focusing on advancements and remaining challenges.
  • To highlight the evolving role of therapies like ARNIs and left ventricular assist devices (LVADs).
  • To discuss the limited treatment options for HFpEF and the need for novel therapeutic approaches.

Main Methods:

  • Review of current literature on heart failure epidemiology, pathophysiology, and treatment efficacy.
  • Analysis of guideline recommendations for pharmacologic and device-based therapies.
  • Examination of ongoing research into novel drug mechanisms for HFrEF and HFpEF.

Main Results:

  • Angiotensin receptor neprilysin inhibitors (ARNIs) demonstrate improved outcomes compared to enalapril, leading to guideline recommendations for their use in HFrEF.
  • Left ventricular assist devices (LVADs) are increasingly utilized in severe HF due to improved safety.
  • No definitive therapy has emerged for HFpEF, despite some evidence for spironolactone.

Conclusions:

  • While advancements in HFrEF treatment, including ARNIs and LVADs, are improving patient outcomes, HFpEF remains a therapeutic challenge.
  • Novel drug development, including cardiac myosin activators, is crucial for addressing the unmet needs in both HFrEF and HFpEF.
  • Continued research is essential to develop effective treatments for the growing population affected by heart failure.

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