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.
