Traditional and novel approaches to management of heart failure: successes and failures.
Although considerable progress has been made in the pharmacologic and device management of chronic heart failure in recent decades, heart failure patients continue to remain symptomatic, with high hospitalization and mortality rates. A number of novel agents, including endothelin antagonists and tumor-necrosis factor blockers, have recently failed to improve the clinical outcomes of patients with heart failure. Have we reached a ceiling in preventing the progression of the disease? This article reviews successes and late-stage clinical trial disappointments in the treatment of patients with heart failure. Furthermore, the article discusses how agents that have beneficial effects in heart failure also generally attenuate or reverse ventricular remodeling, whereas the newer agents that have failed to improve clinical outcomes either had no effect on remodeling or have been associated with adverse remodeling.
Anand
Inder S
IS
Division of Cardiology, University of Minnesota Medical School, 420 Delaware Street SE, MMC 508, Minneapolis, MN 55455, USA. anand001@umn.edu
Florea
Viorel G
VG
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage; D047228:Angiotensin II Type 1 Receptor Blockers / Q000008:administration & dosage; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage; D004334:Drug Administration Schedule; D016232:Endothelins / Q000037:antagonists & inhibitors; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D000451:Mineralocorticoid Receptor Antagonists / Q000008:administration & dosage; D015260:Neprilysin / Q000037:antagonists & inhibitors; D011480:Protease Inhibitors / Q000008:administration & dosage
D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D016232:Endothelins; D000451:Mineralocorticoid Receptor Antagonists; D011480:Protease Inhibitors; D015260:Neprilysin