Short-term therapies for treatment of acute and advanced heart failure—why so few drugs available in clinical use, why even fewer in the pipeline?

Piero Pollesello*, Tuvia Ben Gal, Dominique Bettex, Vladimir Cerny, Josep Comin-Colet, Alexandr A. Eremenko, Dimitrios Farmakis, Francesco Fedele, Cândida Fonseca, Veli Pekka Harjola, Antoine Herpain, Matthias Heringlake, Leo Heunks, Trygve Husebye, Visnja Ivancan, Kristian Karason, Sundeep Kaul, Jacek Kubica, Alexandre Mebazaa, Henning MølgaardJohn Parissis, Alexander Parkhomenko, Pentti Põder, Gerhard Pölzl, Bojan Vrtovec, Mehmet B. Yilmaz, Zoltan Papp

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

15 Scopus citations


Both acute and advanced heart failure are an increasing threat in term of survival, quality of life and socio-economical burdens. Paradoxically, the use of successful treatments for chronic heart failure can prolong life but—per definition—causes the rise in age of patients experiencing acute decompensations, since nothing at the moment helps avoiding an acute or final stage in the elderly population. To complicate the picture, acute heart failure syndromes are a collection of symptoms, signs and markers, with different aetiologies and different courses, also due to overlapping morbidities and to the plethora of chronic medications. The palette of cardio-and vasoactive drugs used in the hospitalization phase to stabilize the patient’s hemodynamic is scarce and even scarcer is the evidence for the agents commonly used in the practice (e.g. catecholamines). The pipeline in this field is poor and the clinical development chronically unsuccessful. Recent set backs in expected clinical trials for new agents in acute heart failure (AHF) (omecamtiv, serelaxine, ularitide) left a field desolately empty, where only few drugs have been approved for clinical use, for example, levosimendan and nesiritide. In this consensus opinion paper, experts from 26 European countries (Austria, Belgium, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Israel, Italy, The Netherlands, Norway, Poland, Portugal, Russia, Slovenia, Spain, Sweden, Switzerland, Turkey, U.K. and Ukraine) analyse the situation in details also by help of artificial intelligence applied to bibliographic searches, try to distil some lesson-learned to avoid that future projects would make the same mistakes as in the past and recommend how to lead a successful development project in this field in dire need of new agents.

Original languageEnglish
Article number1834
JournalJournal of Clinical Medicine
Issue number11
StatePublished - Nov 2019


  • Acute heart failure
  • Advanced heart failure
  • Clinical development
  • Levosimendan
  • Regulatory clinical trials
  • Short-term hemodynamic therapy


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