Emerging treatments

Tolvaptan

A vasopressin antagonist that blocks the action of arginine vasopressin at the V2 receptor in renal tubules and promotes aquaresis.[1] Tolvaptan may be used to treat patients with volume overload and resistant hyponatraemia.[1]

Cinepazide

Cinepazide, a vasodilator, was associated with significantly improving symptoms with less adverse effects in patients with decompensated heart failure, compared with dobutamine.[49]

Vericiguat

The US Food and Drug Administration has approved vericiguat, an orally administered soluble guanylate cyclase stimulator, for treatment of chronic heart failure in patients who are hospitalised for heart failure or need outpatient intravenous diuretics. When compared with placebo, it demonstrated a reduced incidence of death from cardiovascular causes or hospitalisation for heart failure in this patient group.[50]​

Other investigational medications

These include ularitide, tezosentan, istaroxime, perhexiline, relaxin, and cardiac myosin activators. These agents are investigational and not routinely used to treat acute heart failure.[51][52][53][54] Adenosine A1- receptor antagonists (e.g., tonapofylline and rolofylline) have failed to show any clinical benefit in initial studies.[55][56] When compared with placebo, rolofylline did not show any benefit in patients with acute heart failure and impaired renal function.[56] In a phase 2 trial of patients with acute heart failure (ejection fraction <40%), treatment with omecamtiv mecarbil (a selective small-molecule activator of cardiac myosin) did not improve the primary end point of dyspnoea, or any pre-specified secondary end point when compared with placebo.[57]

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