Novel pharmacotherapies for heart failure

In this chapter, we summarize the pharmacological treatment of heart failure (HF), a heterogeneous clinical syndrome with complex pathophysiology that, in most cases, ultimately results from left ventricular (LV) remodeling and systolic and/or diastolic dysfunction of the heart. The primary focus of the review is recently approved and emerging pharmacotherapies; guideline directed medical therapy (GDMT) is also briefly discussed. The pharmacologic management of heart failure can be challenging due its underlying heterogeneity and variability in disease trajectory. Currently, neurohormonal blocking agents are the mainstay of GDMT in HF with reduced ejection fraction (HFrEF, LVEF <40%). However, human studies of neurohormonal inhibition have not consistently demonstrated benefit in HF with preserved EF (HFpEF). Moreover, despite therapeutic advances, the mortality rates for both HFrEF and HFpEF remain unacceptably high, indicating that new treatment approaches are needed. Several emerging therapies with novel mechanisms of action are currently under investigation in preclinical and clinical trials and will be discussed in this section.