Investigational and emerging therapies for heart failure
- Wilson S Colucci, MD
Wilson S Colucci, MD
- Section Editor — Heart Failure
- Professor of Medicine
- Boston University School of Medicine
Treatment of heart failure (HF) is aimed at three goals: improvement in symptoms, slowing of disease progression, and prolongation of survival . (See "Overview of the therapy of heart failure due to systolic dysfunction".)
Investigational and emerging therapies for heart failure will be reviewed here. These interventions have been shown to have promise in small studies, as described below, but the risk/benefit ratio and efficacy remain to be proven. Standard therapies for systolic and diastolic HF are discussed elsewhere. (See "Overview of the therapy of heart failure due to systolic dysfunction" and "Treatment and prognosis of diastolic heart failure".)
MODULATION OF HEART RATE OR AUTONOMIC TONE
Parasympathetic nerve stimulation — Decreased parasympathetic nervous system (PNS) activity may contribute to the pathophysiology of heart failure (HF)  but the role of PNS stimulation as a treatment of HF is unknown. Based on animal models showing improvement in HF with PNS stimulation, the potential role of increasing PNS activity in the treatment of systolic HF is being evaluated in humans. Several trials are under way to examine the effects of increasing PNS activity on cardiac structure, function, and clinical outcomes .
Other — Use of beta blocker therapy and sinus node inhibition in patients with HF is discussed separately. (See "Use of beta blockers and ivabradine in heart failure with reduced ejection fraction".)
Vasopeptidase inhibitors — In clinical trials, the vasopeptidase inhibitor omapatrilat was noninferior to angiotensin converting enzyme (ACE) inhibitor in reducing the risk of death and hospitalization in patients with chronic systolic heart failure (HF) [4,5]. However, the clinical utility of vasopeptidase inhibitor therapy for HF is uncertain given the higher risk of angioedema seen with omapatrilat compared to ACE inhibitors [5,6].
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- MODULATION OF HEART RATE OR AUTONOMIC TONE
- Parasympathetic nerve stimulation
- Vasopeptidase inhibitors
- Hawthorn extract
- Growth hormone
- CELL THERAPY
- GENE THERAPY
- Immunosuppressive therapy
- Intravenous immune globulin
- ANTIVIRAL THERAPY
- MECHANICAL THERAPIES
- Continuous aortic flow augmentation
- Inspiratory muscle training
- Enhanced external counterpulsation
- NUTRITIONAL SUPPLEMENTS
- Coenzyme Q10
- SUMMARY AND RECOMMENDATIONS