Acute heart failure: lessons learned, roads ahead

Acute heart failure remains a major challenge for clinicians and healthcare systems. The number of annual hospitalizations for acute heart failure is rising due to the aging of the general population and the increasing prevalence of heart failure. Heart failure is the leading cause of unplanned hospitalizations for patients older than 65 years in developed countries.1–4 These acute events impact the natural history of heart failure progression, as demonstrated by the dramatic increase in the rate of death and rehospitalizations after an acute heart failure episode.5 –7 Similarly, unplanned visits for worsening symptoms requiring intravenous diuretic treatment are also associated with poor prognosis, with a greater than four-fold increase in subsequent mortality.8,9 The available treatment options (primarily diuretics or vasodilators in normo/hypertensive patients) provide symptomatic relief,1,10 but no therapies for acute heart failure have been shown to improve clinical outcomes in prospective, randomized trials. Thus, reducing morbidity and prolonging survival remain major unmet needs for patients with acute heart failure.10 –12 Acute heart failure is an ideal target for development of new therapeutic interventions given its high frequency and negative impact on clinical outcomes. However, substantial investments in research and development have not yielded proof of efficacy and safety for any of the therapies tested.