Old And New Drugs For Treatment Of Advanced Heart Failure

BACKGROUND: End-stage heart failure is a progressive disease with high mortality and limited medical therapeutic options. Heart transplantation remains the gold-standard treatment for these patients but its utility is minimized by the advanced age and multiple comorbidities of affected patients, as well as the limited number of donor organs available. METHODS: We researched alternative medications needed to improve survival and quality of life in patients refractory to standard medical therapy and excluded from cardiac transplantation lists. RESULTS: Promising new inotropic agents have been developed in recent. Waiting for their advent in clinical practice, some small studies showed that traditional drugs can also be effective in improving symptoms and in prolonging survival in the end-stage heart failure. These are: the association of dobutamine infusion with amiodarone or ivabradine in patients with symptomatic hypotension, and high-dose furosemide associated to hypertonic saline solution, levosimendan, hydralazine/isosorbide dinitrate, sodium nitroprusside or ivabradine in hemodynamically stable patients. Among newer inotropes, istaroxime represents the most promising agent for the treatment of cardiogenic shock, having been the only one to show an increasing in blood pressure and a reduction in heart rate. CONCLUSIONS: Traditional drug associations and newer inotropes represent promising agents for the treatment of end-stage heart failure. Large trials are desirable in order to improve prognosis of these life-threatening patients.