Pharmacological options for acute heart failure syndromes: current treatments and unmet needs
Division of Cardiology, University Central Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
* Corresponding author. Tel: +358 94717 2200; fax: +358 94717 4015. E-mail address: markku.nieminen{at}hus.fi
Although acute heart failure represents a major burden on public health worldwide, there has been little research in this field and many treatment strategies are based on clinical experience rather than on evidence from randomized trials. Goals of acute treatment include stabilization of haemodynamics and symptomatic relief. Therapeutic options include digoxin, diuretics, nitrovasodilators, and positive inotropic agents, each of which is associated with clinical limitations. Although digoxin appears to be beneficial in some patients, its role in management of acute heart failure remains uncertain. Diuretics are well established as a mainstay of therapy and provide rapid symptomatic relief, but recent evidence links high-dose diuretic use with adverse outcomes. Nitrovasodilators can improve haemodynamics, but problems with this drug class include tachyphylaxis and dose-related side effects. Positive inotropic agents are useful for increasing cardiac index in patients with low-output heart failure, but there are concerns that inotrope use is associated with a worsened prognosis. It is hoped that the novel therapies that are currently emerging, including the natriuretic peptide nesiritide and the calcium sensitizer levosimendan, will address some of the currently unmet treatment needs without the limitations of current treatments.
Key Words: Acute disease • Congestive heart failure, classification/pathophysiology/therapy • Pharmacotherapy