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 with reduced ejection fraction".)
Investigational and emerging therapies for chronic and acute HF are reviewed here. While beneficial effects have been seen with some of these interventions in preliminary studies, the risk/benefit ratio and true efficacy remain to be proven.
Standard therapies for HF are discussed elsewhere. (See "Overview of the therapy of heart failure with reduced ejection fraction" and "Treatment and prognosis of heart failure with preserved ejection fraction".)
INVESTIGATIONAL THERAPIES FOR CHRONIC HEART FAILURE
Modulation of heart rate or autonomic tone
Parasympathetic 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 HF with reduced ejection fraction (HFrEF) is being evaluated in humans. Several trials are underway to examine the effects of increasing PNS activity via vagus nerve stimulation 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 in heart failure with reduced ejection fraction".)
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- INVESTIGATIONAL THERAPIES FOR CHRONIC HEART FAILURE
- Modulation of heart rate or autonomic tone
- - Parasympathetic stimulation
- - Other
- - Sildenafil
- - Hawthorn extract
- - Testosterone
- - Growth hormone
- Cell therapy
- Gene therapy
- - Immunosuppressive therapy
- - Intravenous immune globulin
- - Immunoadsorption
- - Thalidomide
- - Pentoxifylline
- - Immunomodulation
- Antiviral therapy
- Mechanical therapies
- - Enhanced external counterpulsation
- Nutritional supplements
- - Coenzyme Q10
- INVESTIGATIONAL THERAPIES FOR ACUTE HEART FAILURE
- Investigational vasodilators
- - Serelaxin
- - Ularitide
- Hypertonic saline plus furosemide
- Continuous aortic flow augmentation
- High-dose mineralocorticoid receptor antagonist
- SUMMARY AND RECOMMENDATIONS