title: Newest additions to heart failure treatment.
abstract: BACKGROUND
  Despite the improvement in heart failure (HF) therapy in the last 30 years, this condition remains a major public health concern with high hospitalization and mortality rates, and related costs. Recently, new pharmacological approaches are under evaluation.
  
  
  METHODS
  For chronic HF with reduced ejection fraction (EF) direct renin inhibitors, neprilysin-angiotensin II receptor inhibitors and aldosterone synthase inhibitors have been tested. For HF with preserved EF, no therapy has been demonstrated up to now to be able to improve patients' outcomes and it remains a substantial unmet need. In acute HF (AHF) new inotropes and vasodilators have been developed and are currently investigated in trials. In this review, mechanism of action and clinical efficacy of new pharmacological approaches on acute and chronic HF will be discussed.
  
  
  CONCLUSIONS
  In patients with HF, some unmet needs remain to be challenged in the near future. For patients with chronic HF, the management of comorbidities, a better definition and treatment of patients with preserved EF are the major issues to be solved. The treatment of patients admitted for AHF is even more compelling. Several hypotheses of research focused on these issues are tested in ongoing trials.
authors.affiliation: Azienda Ospedaliero-Universitaria Careggi, Department of Heart and Vessel, Section of Geriatric Medicine and Cardiology , Florence , Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Orso
authors.forename: Gianna
authors.initials: G
authors.lastname: Fabbri
authors.forename: Samuele
authors.initials: S
authors.lastname: Baldasseroni
authors.forename: Aldo P
authors.initials: AP
authors.lastname: Maggioni
mesh_terms: D000208:Acute Disease; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D002986:Clinical Trials as Topic; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D013318:Stroke Volume / Q000187:drug effects
chemical_list: D002317:Cardiovascular Agents
keywords: acute heart failure; chronic heart failure; clinical trials results; pharmacological management