Emerging Treatment Approaches to Improve Outcomes in Patients with Heart Failure

Abstract

Heart failure (HF) is a major public health problem around the world. Although currently available therapies have improved outcomes, morbidity and mortality in patients with HF remain unacceptably high. Most guideline-recommended therapies for HF are indicated for patients with a reduced left ventricular ejection fraction (HFrEF). Until recently, treatment options that improved outcomes in patients with HF and preserved left ventricular ejection fraction or mildly reduced ejection fraction were limited. Over the past several years, however, several new drugs including angiotensin receptor neprilysin inhibitors (ARNIs), sodium glucose cotransporter 2 inhibitors (SGLT2 inhibitors), soluble guanylate cyclase stimulators, and a cardiac myotrope, omecamtiv mecarbil have all reported positive results in pivotal phase III clinical trials. Moreover, the results of these studies have provided evidence that both ARNIs and SGLT2 inhibitors can improve clinical outcomes in patients with HF across a broad spectrum of LVEF, not just in HFrEF. This article presents the rationale for the use of each of these 4 new classes of drugs, reviews the results from pivotal clinical trials showing their safety and efficacy, and provides a framework for how each drug has begun to be integrated into new HF management guidelines. Collectively, these new drugs provide hope for the millions of patients around the world who suffer from HF.