CHRONIC HEART FAILURE (CHF) AND NEW DRUGS: ANALYTICAL REVIEW OF EFFICACY

Abstract

Chronic heart failure (CHF) is a multifactorial clinical syndrome characterized by impaired cardiac pumping function, reduced exercise tolerance, and frequent hospitalizations, posing a significant global health burden. Traditional pharmacotherapy, including ACE inhibitors, beta-blockers, and diuretics, improves symptoms and survival but often fails to fully address disease progression or quality of life. Recent advances in pharmacology have introduced novel therapeutic agents targeting key pathophysiological mechanisms in CHF, including angiotensin–neprilysin inhibitors (ARNIs), sodium–glucose cotransporter-2 (SGLT2) inhibitors, myotropic agents, and anti-inflammatory drugs. These therapies aim to enhance cardiac function, optimize neurohormonal balance, improve myocardial energetics, and reduce systemic inflammation.

Sacubitril/valsartan, an ARNI, combines angiotensin receptor blockade with neprilysin inhibition, enhancing natriuretic peptide activity and promoting vasodilation. Clinical trials demonstrate reduced mortality and hospitalization rates, improved symptom management, and long-term survival benefits in patients with reduced ejection fraction. SGLT2 inhibitors, originally developed for diabetes management, including empagliflozin, have shown cardioprotective effects by reducing renal sodium and glucose reabsorption, promoting diuresis, and enhancing ventricular performance, independent of glycemic control. Omecamtiv mecarbil, a myotropic agent, improves myocardial contractility by stimulating cardiac myosin, demonstrating increased cardiac output in early studies. Anti-inflammatory therapies, such as ziltivekimab, are under investigation for modulating interleukin-6–mediated chronic inflammation that contributes to cardiac and vascular dysfunction.

Evidence from major international guidelines, including ACCF/AHA 2022 and ESC 2023, emphasizes the integration of these novel therapies with standard care to optimize neurohormonal regulation, mitigate disease progression, and address comorbidities such as iron deficiency. Comparative analyses highlight that ARNIs and SGLT2 inhibitors consistently produce favorable outcomes in mortality reduction, hospitalizations, and functional capacity, whereas myotropic and anti-inflammatory agents are emerging as promising adjuncts in selected patient populations. Safety profiles are generally acceptable, but long-term data and individualized therapy considerations remain critical for optimal clinical application.