title: New medications for heart failure.
abstract: Heart failure is common and results in substantial morbidity and mortality. Current guideline-based therapies for heart failure with reduced ejection fraction, including beta blockers, angiotensin converting enzyme (ACE) inhibitors, and aldosterone antagonists aim to interrupt deleterious neurohormonal pathways and have shown significant success in reducing morbidity and mortality associated with heart failure. Continued efforts to further improve outcomes in patients with heart failure with reduced ejection fraction have led to the first new-in-class medications approved for heart failure since 2005, ivabradine and sacubitril/valsartan. Ivabradine targets the If channels in the sinoatrial node of the heart, decreasing heart rate. Sacubitril/valsartan combines a neprilysin inhibitor that increases levels of beneficial vasodilatory peptides with an angiotensin receptor antagonist. On a background of previously approved, guideline-directed medical therapies for heart failure, these medications have shown improved clinical outcomes ranging from decreased hospitalizations in a select group of patients to a reduction in all-cause mortality across all pre-specified subgroups. In this review, we will discuss the previously established guideline-directed medical therapies for heart failure with reduced ejection fraction, the translational research that led to the development of these new therapies, and the results from the major clinical trials of ivabradine and sacubitril/valsartan.
authors.affiliation: Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA.
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Gordin
authors.affiliation: Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA; Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles Medical Center, Los Angeles, CA. Electronic address: gfonarow@mednet.ucla.edu.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
mesh_terms: D000613:Aminobutyrates / Q000009:adverse effects / Q000627:therapeutic use*; D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects / Q000627:therapeutic use*; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001552:Benzazepines / Q000009:adverse effects / Q000627:therapeutic use*; D001713:Biphenyl Compounds; D054815:Cyclic Nucleotide-Gated Cation Channels / Q000037:antagonists & inhibitors / Q000378:metabolism; D004338:Drug Combinations; D006333:Heart Failure / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D000077550:Ivabradine; D015260:Neprilysin / Q000037:antagonists & inhibitors / Q000378:metabolism; D017410:Practice Guidelines as Topic; D011480:Protease Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D020127:Recovery of Function; D015398:Signal Transduction / Q000187:drug effects; D013318:Stroke Volume / Q000187:drug effects; D013777:Tetrazoles / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D000068756:Valsartan
chemical_list: D000613:Aminobutyrates; D047228:Angiotensin II Type 1 Receptor Blockers; D000889:Anti-Arrhythmia Agents; D001552:Benzazepines; D001713:Biphenyl Compounds; D054815:Cyclic Nucleotide-Gated Cation Channels; D004338:Drug Combinations; D011480:Protease Inhibitors; D013777:Tetrazoles; D000077550:Ivabradine; D000068756:Valsartan; D015260:Neprilysin; C549068:sacubitril and valsartan sodium hydrate drug combination
keywords: Funny channel; Heart failure therapies; Ivabradine; Neprilysin; Sacubitril/valsartan