New Treatments for Acute Cardiac Failure

Abstract

Acute heart failure is one of the most common reasons for consulting in the emergency room and admission to intensive care. The in-hospital mortality and the risk for early readmission are high, around 8 and 25%, respectively. A little change in international recommendations on drug therapy has occurred over the past 2 decades. It includes diuretics and vasodilators in preserved blood pressure and inotropes in cardiogenic shock. According to registry data, there appears to be a significant failure to use vasodilators in normotensive patients and conversely, a high use of inotropic as compared to the rate of cardiogenic shock. New molecules are under development, whose clinical validation is difficult and raises the issue of the most relevant endpoints. In the class of vasodilators, serelaxin, ularitide, clevidipine, and guanylate-cyclase agonists are being evaluated through several studies. Inotropic class has been enlarged by drugs with different mechanisms of action; levosimendan has been largely developed with mixed results and omecamtiv is being evaluated. Finally, tolvaptan has shown an interesting potential in diuretic class.