What can be expected for the management of heart failure in the near future?

Further reduction in the morbidity and mortality from diseases associated with heart failure is to be expected by the early introduction of strategies aimed at preventing cardiac damage. In the future, ACE inhibitors, beta-adrenergic blocking agents and type III antiarrhythmic agents, as well as pacemakers, will be used judiciously and in combination following better risk profiling using non-invasive techniques. Cardiac transplantation could be a more widely used treatment for end-stage cardiac disease. Ongoing randomized studies are revealing the usefulness of various pharmaceutical products as well as implanted defibrillators. In the more distant future, anti-endothelin therapy, cardiac autoantibody immunotherapy, cardiac-specific inhibition of angiotensin-converting enzyme and/or normalization of autonomic parasympathetic activity by parasympathomimetic agents may prove to be additional tools for reducing the complications from cardiac disease.