Background: Advanced heart failure (HF) is a progressive disease with high mortality and limited
medical therapeutic options. Long-term mechanical circulatory support and heart transplantation remain goldstandard
treatments for these patients; however, access to these therapies is limited by the advanced age and multiple
comorbidities of affected patients, as well as by the limited number of organs available.
Methods: Traditional and new drugs available for the treatment of advanced HF have been researched.
Results: To date, the cornerstone for the treatment of patients with advanced HF remains water restriction, intravenous
loop diuretic therapy and inotropic support. However, many patients with advanced HF experience loop
diuretics resistance and alternative therapeutic strategies to overcome this problem have been developed, including
sequential nephron blockade or use of the hypertonic saline solution in combination with high-doses of furosemide.
As classic inotropes augment myocardial oxygen consumption, new promising drugs have been introduced,
including levosimendan, istaroxime and omecamtiv mecarbil. However, pharmacological agents still remain
mainly short-term or palliative options in patients with acute decompensation or excluded from mechanical
Conclusion: Traditional drugs, especially when administered in combination, and new medicaments represent
important therapeutic options in advanced HF. However, their impact on prognosis remains unclear. Large trials
are necessary to clarify their therapeutic potential and prognostic role in these fragile patients.