Jebmh.com Review Article J. Evid. Based Med. Healthc., pISSN- 2349-2562, eISSN- 2349-2570/ Vol. 3/Issue 33/Apr. 25, 2016 Page 1604 NEW HORIZONS IN THE MANAGEMENT OF HEART FAILURE Puneeta Gupta 1 , Abhinav Gupta 2 , Tejasvi Sharma 3 , Anil K. Gupta 4 , Rajesh Gupta 5 1 Professor, Department of Internal Medicine, Acharaya Shri Chander College of Medical Sciences, Sidhra, Jammu. 2 Assistant Professor, Department of Internal Medicine, Acharaya Shri Chander College of Medical Sciences, Sidhra, Jammu. 3 Post Graduate Student, Department of Internal Medicine, Acharaya Shri Chander College of Medical Sciences, Sidhra, Jammu. 4 HOD, Department of Internal Medicine, Acharaya Shri Chander College of Medical Sciences, Sidhra, Jammu. 5 Consultant, Department of Medicine, Government Medical College, Jammu. ABSTRACT INTRODUCTION Heart failure (HF) is a global problem with an estimated prevalence of 38 million people worldwide; a number that is increasing with the ageing of the population. The heart failure is associated with high health expenditure, mostly because of cost of hospitalisations. The five year survival for individuals with heart failure is about 50%, and in advanced heart failure, the one year survival is as low as 22%, regardless of therapy. The modern history of therapy for heart failure with reduced ejection fraction began with the introduction of vasodilatation with hydralazine plus isosorbide dinitrate. Research about heart failure is now quite active worldwide and many areas are being explored e.g. gene therapy, modification of function of micro RNAs by antagomirs, stem cell therapy besides development of new pharmacological therapeutic agents. KEYWORDS Heart failure, ejection fraction, angiotensin converting enzyme, stem cells and gene therapy. HOW TO CITE THIS ARTICLE: Gupta P, Gupta A, Sharma T, et al. New horizons in the management of heart failure. J. Evid. Based Med. Healthc. 2016; 3(33), 1604-1607. DOI: 10.18410/jebmh/2016/360 INTRODUCTION: In developed countries, around 2% of adults have heart failure and in those over the age of 65, this is the most common diagnosis; resulting in more than one million hospitalisations annually. There is dearth of data regarding incidence and prevalence of HF not only from India, but the whole of developing world. The present estimates about the incidence and prevalence in developing world are mostly extrapolated from the data collected in western nations. Based on government data, prevalence of heart failure in India ranges anywhere between 1.3 to 4.6 million, with an annual incidence of 491,600 to 1.8 million cases. The total cost involved has been estimated to amount to 2% of total budget of National Health Service in United Kingdom, and more than $35 billion in United States. Nearly, one out of every four patients hospitalised in US with congestive heart failure is readmitted within 30 days. Additionally, more than 50% of the patients seek readmission within 6 months after treatment. Thus, despite some progress, prognosis of heart failure is worse than that of most cancers. Although the outcomes for ambulatory HF patients with a reduced ejection fraction (EF) have improved with the discovery of multiple evidence based drug and device therapies, hospitalised heart failure (HHF) patients continue to experience unacceptably high post-discharge mortality and readmission rates, that have not changed in the last 2 decades. 1,2,3,4,5 Review of Literature: Treatment of heart failure: 28 years of evidence based management: The clinical trials in the last decade of 20 th century established that angiotensin-converting–enzyme (ACE) inhibition with enalapril reduced overall mortality by 16 to 40% and that enalapril’s benefit in reducing the rate of hospitalisations for heart failure extended even to asymptomatic patients with reduced ejection fraction. The closely related class of drugs, the angiotensin-receptor blocker (ARBs) interfere with the action of angiotensin II at its type 1 receptor, resulting in vasodilatation. However, as effects of ARBs on mortality has been inconsistent, these drugs are recommended primarily for patients who have unacceptable side effects while receiving ACE inhibitors. 6 The use of beta-blocker therapy, now a cornerstone of heart-failure treatment, was once considered counterintuitive, because of concern that patients with reduced ejection fraction either would not benefit or would have unacceptable side effects. After this, in an important clinical trial, it was reported that addition of spironolactone, a mineralocorticoid-receptor antagonist (MRA), resulted in a 30% reduction in mortality among patients already receiving an ACE inhibitor and a loop diuretic. 6,7 An older class of inotropic agents, the cardiac glycosides; however, proved a disappointment when the results of the clinical trials showed unequivocally that digoxin had no beneficial effect on mortality in heart failure, though it did reduce overall hospitalisations by about 28%. Therefore, despite their long history, cardiac Financial or Other, Competing Interest: None. Submission 21-03-2016, Peer Review 04-04-2016, Acceptance 12-04-2016, Published 25-04-2016. Corresponding Author: Dr. Puneeta Gupta, H. No. 384, Sector-5, Channi Himmat, Jammu. E-mail: drpuneetagupta1@gmail.com DOI: 10.18410/jebmh/2016/360