title: Evolving therapies for the management of chronic and acute decompensated heart failure.
abstract: OBJECTIVE
  The pharmacology, clinical efficacy, and safety profiles of evolving therapies for the management of chronic heart failure (HF) and acute decompensated heart failure (ADHF) are described.
  
  
  CONCLUSIONS
  HF confers a significant financial burden despite the widespread use of traditional guideline-directed medical therapies such as angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, β-blockers, and aldosterone receptor antagonists, and the rates of HF-related mortality and hospitalization have remained unacceptably high. In response to a demand for novel pharmacologic agents, several therapeutic compounds have recently gained approval or are currently under review by the Food and Drug Administration. Sacubitril-valsartan has demonstrated benefit in reducing cardiovascular mortality and HF-related hospitalizations in clinical trials, while ivabradine and ferric carboxymaltose have proven efficacious in reducing HF-related hospitalizations. Lastly, the role of serelaxin in ADHF is currently under investigation in an ongoing Phase III study. While large, outcome-driven clinical trials are fundamental in informing the clinical application of these therapeutic agents, careful patient selection is imperative to ensuring similar outcomes postmarketing. In addition, optimization of current guideline-directed medical therapy remains essential as new therapies emerge and are incorporated into guideline recommendations. Additional therapeutic agents currently undergoing investigation include bucindolol hydrochloride, cimaglermin alfa, nitroxyl, omecamtiv mecarbil, TRV027, and ularitide. Clinical practitioners should remain abreast of emerging literature so that new therapeutic entities are optimally applied and positive patient outcomes are achieved.
  
  
  CONCLUSIONS
  Recently introduced agents for the treatment of patients with HF include sacubitril-valsartan, ivabradine, and ferric carboxymaltose. Additional agents worthy of attention include serelaxin and other therapies currently under investigation.
authors: Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC.
authors: Jennifer C
authors: JC
authors: Cook
authors: Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC.
authors: Richard H
authors: RH
authors: Tran
authors: Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC.
authors: J Herbert
authors: JH
authors: Patterson
authors: Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC. jerodgers@unc.edu.
authors: Jo E
authors: JE
authors: Rodgers
mesh_terms: D000208:Acute Disease; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000613:Aminobutyrates / Q000627:therapeutic use; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001552:Benzazepines / Q000627:therapeutic use; D001713:Biphenyl Compounds; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D002986:Clinical Trials as Topic / Q000379:methods; D019468:Disease Management; D004338:Drug Combinations; D005290:Ferric Compounds / Q000627:therapeutic use; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D000077550:Ivabradine; D008320:Maltose / Q000031:analogs & derivatives / Q000627:therapeutic use; D013777:Tetrazoles / Q000627:therapeutic use; D000068756:Valsartan
chemical_list: D000319:Adrenergic beta-Antagonists; D000613:Aminobutyrates; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D001552:Benzazepines; D001713:Biphenyl Compounds; D002317:Cardiovascular Agents; D004338:Drug Combinations; D005290:Ferric Compounds; D013777:Tetrazoles; D000077550:Ivabradine; C522335:ferric carboxymaltose; D008320:Maltose; D000068756:Valsartan; C549068:sacubitril and valsartan sodium hydrate drug combination