Emerging treatments

Your Organisational Guidance

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Behandeling acuut cardiogeen longoedeem in een urgente situatie (in afwachting van hospitalisatie)Published by: Werkgroep Ontwikkeling Richtlijnen Eerste Lijn (Worel)Last published: 2022La prise en charge de l’oedème pulmonaire aigu cardiogénique en situation d'urgence (en attente d'une hospitalisation)Published by: Groupe de Travail Développement de recommmandations de première ligneLast published: 2022

Acetazolamide

Acetazolamide is a carbonic anhydrase inhibitor and diuretic shown to increase the incidence of successful decongestion when added to a loop diuretic for patients with acute decompensated heart failure, compared to placebo.[69] However, it is not yet in widespread use for this indication, and further data on outcomes and safety are needed.[41]​​​​

Sotaglifozin

Sotagliflozin is a dual sodium-glucose cotransporter-1 (SGLT1)/SGLT2 inhibitor.[70] It has been approved by the US Food and Drug Administration (FDA) to reduce the risk of cardiovascular death, hospitalisation for heart failure, and urgent heart failure visit in adults with: heart failure; or type 2 diabetes mellitus, chronic kidney disease, and other cardiovascular risk factors. It is not approved for use in Europe or the UK as yet.

Tolvaptan

A vasopressin antagonist that blocks the action of arginine vasopressin at the V2 receptor in renal tubules and promotes aquaresis.[1][71][72]​​​ 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.[73]

Vericiguat

The European Medicines Agency and the US Food and Drug Administration have 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 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.[74]

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.[75][76][77][78][79] Adenosine A1- receptor antagonists (e.g., tonapofylline and rolofylline) have failed to show any clinical benefit in initial studies.[80][81] When compared with placebo, rolofylline did not show any benefit in patients with acute heart failure and impaired renal function.[81] 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.[82]

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