Recent developments in the treatment of heart failure: highlights from the American Heart Association's Scientific Sessions, Los Angeles, California, 3 – 7 December 2012

Abstract

Over the last decade, the treatment of heart failure has seen the introduction of several novel therapeutic avenues into the guidelines; however, these were mostly devoted to device therapies. Not much has changed with regards to the pharmacological treatment of this syndrome. Serelaxin, a recombinant form of the human peptide hormone relaxin-2, is a promising treatment candidate for patients presenting with acute heart failure. The Relaxin in Acute Heart Failure (RELAX-AHF) trial has shown beneficial effects in terms of relief of dyspnea and congestion in these patients. Even beneficial effects on short-term survival were reported. Another treatment approach to acute heart failure was pursued in the Cardiorenal Rescue Study in Acute Decompensated Heart Failure (CARRESS-HF) trial but the ultrafiltration used here lead to significantly worsened renal function as compared to standard pharmacologic care. Multicenter Automatic Defibrillator Implantation Trial – Reduce Inappropriate Therapy (MADIT-RIT) randomized patients with heart failure with a primary preventive indication for the implantation of an implantable cardioverter defibrillator to one of three algorithms for anti-tachycardia pacing (ATP) and shock. The authors found that initiation of such therapies only at higher heart rates than commonly used as threshold and longer time delays before the initiation of therapy may have two big advantages: the more conservative algorithms lead to a significant reduction in the cumulative probability of first inappropriate therapy and, even more striking, a reduced probability of death during follow-up. Biventricular versus Right Ventricular Pacing in Patients with Left Ventricular Dysfunction and Atrioventricular Block (BLOCK-HF) showed beneficial outcomes for cardiac resynchronization therapy in heart failure patients with a mere pacemaker indication. Other studies discussed here embraced the course of body wasting, particularly cachexia, and muscle wasting in patients with heart failure and the influence of eating behavior.