What is evidence-based, what is new in medical therapy of acute heart failure?

Acute decompensated heart failure (ADHF) has become the leading cause of hospitalization in patients > 65 years of age. Traditional drug therapy for ADHF has remained unchanged for many years including morphine, diuretics, nitrates and inotropic agents in addition to oxygen supplementation and mechanical ventilatory support, if necessary. In the year 2005, the European Society of Cardiology published new guidelines for diagnosis and treatment of ADHF. These guidelines emphasize that ADHF is not a disease entity but a complex syndrome with various etiologies and several distinct clinical conditions as a result of systolic and/or diastolic left and/or right ventricular dysfunction. This review article describes the current role of traditional drugs for ADHF as well as the role of newer concepts including vasodilators like the recombinant human brain peptide nesiritide, endothelin antagonists or vasopressin antagonists and newer inotropic agents like the calcium sensitizer levosimendan.