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Recent successes in heart failure treatment

Nature Medicine volume 29, pages 2424–2437 (2023)Cite this article

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Abstract

Remarkable recent advances have revolutionized the field of heart failure. Survival has improved among individuals with heart failure and a reduced ejection fraction and for the first time, new therapies have been shown to improve outcomes across the entire ejection fraction spectrum of heart failure. Great strides have been taken in the treatment of specific cardiomyopathies such as cardiac amyloidosis and hypertrophic cardiomyopathy, whereby conditions once considered incurable can now be effectively managed with novel genetic and molecular approaches. Yet there remain substantial residual unmet needs in heart failure. The translation of successful clinical trials to improved patient outcomes is limited by large gaps in implementation of care, widespread lack of disease awareness and poor understanding of the socioeconomic determinants of outcomes and how to address disparities. Ongoing clinical trials, advances in phenotype segmentation for precision medicine and the rise in technology solutions all offer hope for the future.

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Fig. 1: Modern history of heart failure treatment.
Fig. 2: Indications and mechanisms of action of heart failure medications.
Fig. 3: Phenomapping in heart failure.

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Acknowledgements

The authors acknowledge K. Tiew-Hwa Teng for help with formatting this paper for submission.

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Authors and Affiliations

  1. Duke-NUS Medical School, Singapore, Singapore

    Carolyn S. P. Lam

  2. National Heart Centre Singapore, Singapore, Singapore

    Carolyn S. P. Lam

  3. University Medical Center Groningen, Groningen, the Netherlands

    Carolyn S. P. Lam

  4. University of Glasgow, School of Cardiovascular and Metabolic Health, Glasgow, UK

    Kieran F. Docherty & John J. V. McMurray

  5. CardioVascular Institute and Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Jennifer E. Ho

  6. Department of Cardiology, Akershus University Hospital, Lørenskog, Norway

    Peder L. Myhre & Torbjørn Omland

  7. K.G. Jebsen Center for Cardiac Biomarkers, University of Oslo, Oslo, Norway

    Peder L. Myhre & Torbjørn Omland

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Correspondence to Carolyn S. P. Lam.

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Competing interests

C.S.P.L. is supported by a Clinician Scientist Award from the National Medical Research Council of Singapore; has received research support from Novo Nordisk and Roche Diagnostics; has received consulting fees from Alleviant Medical, Allysta Pharma, Amgen, AnaCardio AB, Applied Therapeutics, AstraZeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Bristol Myers Squibb, CardioRenal, Cytokinetics, Darma, EchoNous, Eli Lilly, Impulse Dynamics, Intellia Therapeutics, Ionis Pharmaceutical, Janssen Research & Development, Medscape/WebMD Global, Merck, Novartis, Novo Nordisk, Prosciento, Quidel Corporation, Radcliffe Group, Recardio, ReCor Medical, Roche Diagnostics, Sanofi, Siemens Healthcare Diagnostics and Us2.ai; and is a cofounder and nonexecutive director of Us2.ai. The employer of K.F.D., the University of Glasgow, has been remunerated by AstraZeneca for work relating to clinical trials. K.F.D. has received speaker’s honoraria from AstraZeneca, Pharmacosmos and Radcliffe Cardiology, has served on an advisory board for Us2.ai and Bayer AG, served on a clinical endpoint committee for Bayer AG, and has received grant support from Boehringer Ingelheim, Roche Diagnostics and AstraZeneca (paid to the institution of K.F.D.). J.E.H. is supported by National Institutes of Health grants R01 HL134893, R01 HL140224, R01HL160003 and K24 HL153669. J.E.H. has also received past research funding from Bayer, AG. J.J.V.M. has received support from a British Heart Foundation Centre of Research Excellence Grant RE/18/6/34217 and the Vera Melrose Heart Failure Research Fund; has received payments through Glasgow University from work on clinical trials, consulting and other activities from Amgen, AstraZeneca, Bayer, Cardurion, Cytokinetics, GlaxoSmithKline, KBP Biosciences and Novartis; has received personal consulting fees from Alnylam Pharma, Bayer, Bristol Myers Squibb, George Clinical PTY, Ionis Pharma, Novartis, Regeneron Pharma and River 2 Renal; has received personal lecture fees from Abbott, Alkem Metabolics, AstraZeneca, Blue Ocean Scientific Solutions, Boehringer Ingelheim, Canadian Medical and Surgical Knowledge, Emcure Pharma, Eris Lifesciences, European Academy of CME, Hikma Pharmaceuticals, Imagica Health, Intas Pharma, J.B. Chemicals and Pharma, Lupin Pharma, Medscape/theheart.org, ProAdWise Communications, Radcliffe Cardiology, Sun Pharma, The Corpus, Translation Research Group and Translational Medicine Academy; and is a director of Global Clinical Trial Partners. P.L.M. has received research support from AstraZeneca and received consulting fees from AstraZeneca, Bayer, Bristol Myers Squibb, Boehringer Ingelheim, Novartis, Novo Nordisk, Orion Pharma, Pharmacosmos, Sanofi, Us2.ai and Vifor. T.O. has received research support from Abbott Diagnostics, ChromaDex, Novartis and Roche Diagnostics; consulting fees and/or speaker honoraria from Abbott Diagnostics, Bayer, CardiNor and Roche Diagnostics; and stock and stock options from CardiNor.

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Lam, C.S.P., Docherty, K.F., Ho, J.E. et al. Recent successes in heart failure treatment. Nat Med 29, 2424–2437 (2023). https://doi.org/10.1038/s41591-023-02567-2

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