Paradigm Shifts of Heart Failure Therapy: Do We Need Another Paradigm?

Heart failure (HF) is a progressive condition with intermittent acute decompensation leading to poor prognosis despite established guideline-directed therapy. A paradigm of HF therapy has been shifted over last four decades. Until the early 1970s, HF was empirically managed, then was managed with the hemodynamic concept until the early 1980s. According to the results of large randomized clinical trials, HF therapy has been shifted to the neurohormonal paradigm since the late 1980s until recently. Korean Acute Heart Failure (KorAHF) registry is a multi-center registry that recruited a total of 5625 admitted patients with acute HF from 2011 to 2014 and followed until 2019. Through KorAHF registry, we could obtain invaluable information or messages in various fields such as epidemiology, clinical characteristics, and treatment of acute HF in Korea and also had opportunities to fill the gap between guideline-directed care and real-world practice. Considering significant unmet needs in HF therapy even at this moment, we do need another paradigm shift for HF therapy, such as molecular and regenerative paradigm using gene, stem cells, mechanical support as well as novel pharmacological agents.