Evolution of Heart Failure Pharmacotherapy

Heart Failure is a chronic disease with increasing prevalence around the world. It is associated with significant mortality, morbidity, and healthcare costs. Over the past 2-3 decades, major advances in drug development have contributed significantly in decreasing mortality among those with chronic systolic heart failure. However, similar advances are missing in patients experiencing acute heart failure and heart failure with preserved ejection fraction. In the current chapter, we will review the historical development of pharmacotherapy in heart failure medical management. A comparative review of contribution of each class towards reducing mortality will be performed. More importantly, drugs which failed to succeed or impact significantly will be reviewed and an insight on why they may have failed will be provided. Development of new drugs is limited by regulatory requirements as well as disease heterogeneity. New agents under development will be summarized and mode of their action will be detailed. This chapter aims to serve as a comprehensive resource on strategies both past and current as well as provide discussion regarding potential future developments in heart failure pharmacotherapy.

Keywords: ACE inhibitors, Aldosterone antagonists, Beta blockers, BiDil, Diastolic dysfunction, Digoxin, Diuretics, Dobutamine, Heart decompensation, Heart failure, History, Ibopamine, Ivabradine, Milrinone, Natriuretic peptides, Novel therapies, Pharmacology, Statin, Systolic dysfunction, Vasodilator.