Evolving targets for heart failure: the journey so far

The treatment of heart failure has included vasodilators, positive inotropes and most successfully neurohormonal blockade. Recent research has looked at metabolic and immune modulatory approaches, and implantable, mainly electrical devices. The near future in pharmacological research for heart failure remains focused on classic methodologies and small molecules, but despite significant improvements we still know relatively little of the complex interactions in heart failure, particularly for heart failure with preserved ejection fraction. Pharmacotherapy will in future be combined with advances in biotechnology, nanotechnology and devices and a digital revolution will help us to monitor patients at a distance, using wireless devices. Heart failure research has achieved much over the last 4 decades, but the pace of innovation and research has not abated and future advances in this disabling condition are indeed likely.