Heart Failure Management, including Recently Approved Therapeutic Options: An Overview

Abstract

Heart failure (HF) affects the heart's structure and function. It is considered a complex clinical syndrome attributed to any anatomic or physiologic impairment of the ejection of blood or ventricular filling. The incidence of this clinical condition is increasing and causing a significant impact on healthcare systems worldwide. Since the pathophysiology of HF is well understood, treatment options have had significant advancements. Initially, many compensatory mechanisms are helpful, but over time they contribute to the progression of the disease, such as increased adrenergic activity, renin-angiotensin-aldosterone system activity, and secretion of B-type natriuretic peptide (BNP). These may cause progressive myocardial damage. For this reason, different groups of drugs are used for managing HF, targeting different points of the physiopathology of HF. An instance is the drug combination sacubitril/valsartan, which increases BNP levels while simultaneously inhibiting the renin-angiotensin system (RAS). Other examples include sodium-glucose cotransporter 2 inhibitors (SGLT2i), which lower blood pressure, soluble guanylate cyclase (sGC) stimulators that cause smooth muscle relaxation and vasodilation, beta-blockers (BBs), which lower heart rate and contractility, and mineralocorticoid receptor antagonists (MRAs), which maintain water and electrolyte homeostasis. This article is aimed to identify when these medications are recommended, and to point out the recently FDA-approved SGLT2i and soluble guanylyl cyclase (sGC) stimulator (vericiguat), taking into account their adverse effects, symptoms, and comorbidities of the patient that may worsen the disease process.