New therapeutic agents for the management of congestive heart failure

During the past year, several important studies have strongly supported the use of what we now view as the three-pronged, "standard" approach to the treatment of symptomatic heart failure: diuretics, digoxin, and angiotensin-converting enzyme inhibitors. New information regarding the latter two agents is reviewed elsewhere in this issue of Current Opinion in Cardiology. However, despite obvious advances in our management of this important clinical syndrome and the substantial body of evidence supporting the beneficial effects of the angiotensin-converting enzyme inhibitors, the prognosis for patients with symptomatic congestive heart failure remains abysmal. For this reason, new and novel agents for the pharmacologic treatment of patients with heart failure continue to be developed and clinically evaluated. This article reviews the results of recent clinical trials with some of these new investigational pharmacologic agents. To facilitate categorization of these new agents, they will be grouped according to their primary pharmacologic action. However, it should be noted that those pharmacologic actions may not necessarily be responsible for either the beneficial or deleterious effects associated with these agents.