Emerging treatments

Tolvaptan

A vasopressin antagonist that may relieve symptoms of acute heart failure, but may not reduce morbidity or mortality.[103][104][105]​​​ Tolvaptan should be considered for patients with volume overload, hyponatremia (<130 mEq/L), and symptoms of hyponatremia for the short-term correction of hyponatremia and associated symptoms.[36]

Cinepazide

Cinepazide, a vasodilator, was associated with significantly improving symptoms with less adverse effects in patients with decompensated heart failure, compared with dobutamine.[106]

Vericiguat

Vericiguat is an oral soluble guanylate cyclase stimulator (vasodilator) approved by the Food and Drug Administration for use in adults with symptomatic chronic heart failure and ejection fraction less than 45% (high-risk heart failure), who have recently been hospitalized or received outpatient intravenous diuretics. When compared with placebo, it demonstrated a reduced incidence of death from cardiovascular causes or hospitalization for heart failure in this patient group.[107]

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.[108][109][110][111]​​ Adenosine A1- receptor antagonists (e.g., tonapofylline and rolofylline) have failed to show any clinical benefit in initial studies.[112][113] When compared with placebo, rolofylline did not show any benefit in patients with acute heart failure and impaired renal function.[113] In one 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 dyspnea, or any prespecified secondary end point when compared with placebo.[114]

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