Hospital Pharmacy - April 2018 - 85

750096
research-article2017

HPXXXX10.1177/0018578717750096Hospital PharmacyDahn and Walker

Pharmaceutical Pipeline Update

New Medications in the Treatment of
Acute Decompensated Heart Failure

Hospital Pharmacy
2018, Vol. 53(2) 85-87
© The Author(s) 2017
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https://doi.org/10.1177/0018578717750096
DOI: 10.1177/0018578717750096
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Ryan Dahn1 and Scot Walker2

Abstract
Acute decompensated heart failure is a sudden worsening of heart failure symptoms, typically resulting in peripheral edema
and dyspnea as a result of pulmonary congestion. Acute decompensated heart failure is responsible for over 1 million
hospitalizations every year. Current pharmacologic therapy is limited in its options. Despite an improved survival rate,
statistic still suggests that about 50% of patients die within 5 years of diagnosis. New pharmacologic agents aim to improve
efficacy by targeting previously unexplored physiological pathways.
Keywords
investigational drugs, formulary management/P&T, cardiovascular, drug information

Epidemiology
The lifetime risk for developing heart failure in a patient
over 40 years of age is 20% with the risk increasing as age
increases.1 Almost 5 million people in the United States
have heart failure, with a higher prevalence in men than
women.2 Heart failure is responsible for over 1 million hospitalizations annually, with 80% of these hospitalizations
caused by acute decompensation.3 As of 2013, the readmission rate of patients hospitalized with acute decompensated
heart failure was 25%.1 The total annual cost for heart failure was $30.7 billion in 2012 and is predicted to increase to
$69.7 billion by 2030.2

Current Treatment
Current pharmacologic therapy for acute decompensated
heart failure involves correcting volume status using loop
diuretics and decreasing increased filling pressures and afterload with vasodilators. Oxygen therapy is added to treat
respiratory distress, respiratory acidosis, and/or hypoxia.1 In
addition, maintenance medications are typically reviewed
and adjusted. Continuation or adjustment of maintenance
medications such as an angiotensin-converting enzyme
(ACE) inhibitor, an angiotensin receptor blocker (ARB), or
an angiotensin receptor blocker neprilysin inhibitor (ARNI),
plus a beta blocker, mineralocorticoid receptor antagonist,
and a loop diuretic depends on the patient's hemodynamic
and renal status.1
Despite these medications showing symptomatic improvement and prolonging survival, the patient's health-related
quality of life is not always improved by medications alone.2

A worsening of renal function in patients with acute decompensated heart failure has been seen in 25% to 33% of
patients. Patients can progress to diuretic resistance and
require the use of ultrafiltration for fluid removal.4 In addition, the 5-year mortality rate for patients with heart failure
remains high. About 50% of patients die within 5 years of
diagnosis.2

New Treatment Options
Several new medications are in development for acute
decompensated heart failure, with a few showing promising
results (Table 1). RT-100 is a gene therapy that increases
expression of adenylyl cyclase type 6 to improve ejection
fraction. The drug has demonstrated promising results in a
phase II trial.5 RT-100 is unique, in that a single dose was
able to improve ejection fraction at 12 weeks by about 8.2
ejection fraction units.5 A 12-month, phase III trial is planned
to measure the effect of a single intracoronary injection of
RT-100 on cardiovascular events. Urocortin analogues, such
as stresscopin, act on corticotropin-releasing hormone receptors, which results in increased cardiac output, vasodilation,
and reduces peripheral vascular resistance.6 Serelaxin is a
peptide hormone stimulant that has shown mixed results in
its phase III trials but could be beneficial in managing
1

Prescribe Right, LLC, Wildwood, MO, USA
St. Louis College of Pharmacy, MO, USA

2

Corresponding Author:
Scot Walker, Chief Executive Officer, Prescribe Right, LLC,
1602 Westglen Farms Dr, Wildwood, MO 63011, USA.
Email: scot.walker@prescriberight.com
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