New and emerging drugs and device therapies for chronic heart failure in patients with systolic ventricular dysfunction.

Chronic heart failure remains a common end product of cardiovascular diseases and, despite significant advances in therapy, continues to be accompanied by significant morbidity and mortality. Attenuation of neurohumoral overactivation with blockers of the renin-angiotensin-aldosterone system and β-blockers has improved outcome and helped reverse or halt disease progression in many patients; however, despite this, morbidity and mortality have remained elevated, and only marginal advances have occurred over the last few years. How best to combine these various agents continue to be tested but, apart from the addition of aldosterone receptor blockers and reduction of heart rate with ivabradine, advances have been few. Implantable defibrillators and cardiac resynchronization devices have proved to be very beneficial, and the limits of their use are presently still being tested. How best to handle atrial fibrillation in patients with heart failure remains unanswered, but for now, rate control appears to be appropriate in many patients. Surgical ventricular restoration of the left ventricle has not proved to generally be useful, and although the role of coronary artery bypass graft surgery (CABG) is well established in some patients, its use in others is being reevaluated. The use of biomarkers in patients with heart failure has stimulated great interest; however, much work remains before its full potential can be realized. As the complexity of the use of pharmacogenomics in clinical practice becomes clearer, research in the area is intensifying, but much work remains to be done before its use can be clearly outlined in patients with heart failure.