Chronic heart failure: What does the horizon look like?

Purpose of review This review highlights the most recent developments in the field of heart failure with reduced and preserved ejection fraction (HFrEF and HFpEF). Recent findings The largest trial to date in patients with HFrEF demonstrated that LCZ696, a novel combination drug of valsartan and a neprilysin inhibitor, as compared with enalapril, significantly reduced the death rates from any cause and from cardiovascular causes and the rates of hospitalizations for worsening heart failure. Both ivabradine, a novel heart rate lowering therapy, currently approved by the Food and Drug Administration (FDA), and coenzyme Q₁₀, a powerful antioxidant, when used as adjunctive treatment in HFrEF have also been shown to be efficacious in reducing important heart failure-related cardiovascular adverse events. In contrast, clinical trials in HFpEF remain disappointing; however, the recent FDA approval of a novel pulmonary artery pressure monitoring device has the potential to reduce heart failure readmissions in patients with HFpEF or HFrEF. Summary Novel therapies including LCZ696 and ivabradine have the potential to help curb the burden of heart failure in patients with HFrEF. For now, there continues to remains no clear evidence that novel therapeutic interventions modify the natural history of HFpEF.