Milestones in Heart Failure: How Far We Have Come and How Far We Have Left to Go

Abstract

Heart failure is a clinically complex syndrome that results due to the failure of the ventricles to function as pump and oxygenate end organs. The repercussions of inadequate perfusion are seen in the form of sympathetic overactivation and third spacing, leading to clinical signs of increased blood pressure, dyspnea, fatigue, palpitations, etc. This article provided a brief overview of the clinical syndrome of heart failure; its epidemiology, risk factors, symptoms, and staging; and the mechanisms involved in disease progression. This article also described several landmark trials in heart failure that tested the efficacy of first-line drugs such as beta-blockers, angiotensin receptor blockers, angiotensin-converting enzyme inhibitors, and the latest drugs in the field of heart failure: angiotensin receptor neprilysin inhibitors. Most studies described in this article were guideline-setting trials that revolutionized the practice of medicine and cardiology.

Keywords: ace inhibitors and angiotensin receptor blockers; angiotensin neprilysin inhibitor; beta adrenergic blockers; heart failure; heart failure with preserved ejection fraction (hfpef); hfref; review of clinical trials.

Figure 1. Overview of sympathetic stimulation in response to cardiac stress, leading to heart failure

SNS: sympathetic nervous system; RAAS: renin-aldosterone-angiotensin-system; SV: stroke volume; EF: ejection fraction; PVR: peripheral vascular resistance