Here is a strange pair of facts about heart failure. Treatment is better than it has ever been: four drug classes with proven benefit for the reduced form, the first ever medicines for the preserved form, and a new approval as recently as July 2025. And yet the US heart failure death rate has been rising since 2012. Part of the answer sits in a treatment gap: fewer than 1 in 4 eligible patients with reduced ejection fraction actually receive all four recommended medicines.
About 6.7 million US adults live with heart failure, and about 1 in 4 people will develop it in their lifetime. This article covers what treatment looks like today, what researchers are testing right now, and where clinical trials fit in.
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What is approved for heart failure today
Treatment depends on which type you have. Doctors measure this using ejection fraction, how much blood your heart pumps out with each beat.
Reduced ejection fraction (HFrEF) is treated with four drug classes together, known as GDMT:
- An ARNI or ACE inhibitor: relaxes blood vessels, eases the heart's workload (e.g. Entresto)
- A beta blocker: slows and steadies the heart
- An MRA: blocks a hormone that causes fluid buildup and scarring
- An SGLT2 inhibitor: originally a diabetes medication that turned out to protect the heart too
All four are proven to help people live longer. The real problem isn't the science, it's access: fewer than 1 in 4 eligible patients actually get all four.
Preserved ejection fraction (HFpEF), more than half of all heart failure cases, had no proven treatment for decades. That changed fast. SGLT2 inhibitors (Jardiance, Farxiga) were approved for this form in 2022 and 2023. Then in July 2025, the FDA approved finerenone (Kerendia), which cut cardiovascular deaths and heart failure events by 16% in the FINEARTS-HF trial. Two treatments now exist where there were none five years ago.
Devices and procedures. Depending on severity, care can also include defibrillators, pacemakers, valve repair, mechanical pumps, or transplant. Diuretics (water pills) are used across all forms just to manage symptoms.
What researchers are studying now
The biggest story in the field is obesity. It's one of the main drivers of HFpEF, and the newest weight loss medicines are now being tested directly in heart failure. Two examples are recruiting right now: Amgen is testing maridebart cafraglutide in people with HFpEF and obesity, and Novo Nordisk is running a placebo controlled study in heart failure with obesity. Both are built on the same idea: treat the metabolic driver, not just the symptoms.
Exercise and rehabilitation. Not every study tests a drug. The HEART Camp Connect study at the University of Nebraska tests a structured coaching program to help people with HFpEF keep exercising long term, a proven intervention that needs no prescription.
Devices for forms drugs can't fully treat. A cardiac contractility modulation study is testing an implanted device that sends electrical pulses to strengthen the heart's contraction in people with higher ejection fraction. An Impella study in end stage heart failure is looking at whether temporary pump support can help the heart recover. Advanced disease, Stage D, is where device research concentrates.
Kidney and heart together. Heart and kidney failure feed each other. Finerenone's maker is running MOONRAKER, one of the largest heart failure programs ever, more than 15,000 patients across four Phase 3 trials, spanning ejection fractions and including recently hospitalized patients.
Why heart failure research takes time
Two different diseases, one name. HFrEF and HFpEF behave differently and respond to different drugs, so they need separate trials. HFpEF is harder to study: it usually comes together with obesity, diabetes, kidney disease, and atrial fibrillation, so proving a drug works on the heart failure itself requires large, long trials.
Results take years to show up. Heart failure trials track hospitalizations and deaths, and those take years to accumulate. That's why trials enroll thousands of people and run for years, and why each new treatment took nearly a decade to go from idea to approval.
Good treatments aren't reaching patients. Four proven drug classes exist for HFrEF, but fewer than 1 in 4 eligible patients receive all four. Some current studies aren't testing new drugs at all, they're testing better ways to deliver the ones we already have, like pharmacist-led dose adjustments or remote monitoring.
Some groups are hit harder, and underrepresented in research. Black, American Indian, and Alaska Native people have the highest heart failure death rates, and mortality among Black adults under 65 is rising faster than any other group. Trial participants haven't historically reflected that, which is why many current studies now make diverse enrollment an explicit goal. Here's why diversity in clinical trials matters so much
Common myths about heart failure
"Heart failure means the heart has stopped."
No. That's cardiac arrest, a completely different emergency. Heart failure means the heart can't pump or fill well enough. People live with it for years, and treatment keeps improving.
"Nothing can be done."
Outdated. Four drug pillars exist for the reduced form, the preserved form got its first proven medicines this decade, and the newest approval came in July 2025. The real problem isn't a lack of options, it's that too few patients get everything that already works.
"If my ejection fraction is normal, I can't have heart failure."
More than half of all heart failure cases happen with a normal pumping number. The heart squeezes fine but doesn't fill properly. This form, HFpEF, is the fastest growing and the focus of the field's biggest current trials.
"It only affects the elderly."
Age raises risk, but about 1 in 3 US adults already has risk factors that put them at Stage A, and roughly a quarter to a third of adults have pre-heart-failure changes with no symptoms yet. Prevention research targets exactly these groups.
Stages, and what care usually looks like
Doctors describe heart failure with ACC/AHA stages A through D (how far the disease has progressed) and NYHA class I to IV (how limited you feel today). Typical care by stage: at A and B, the focus is treating risk factors like high blood pressure and diabetes before symptoms start. At Stage C, medicines build up toward full GDMT, with the exact combination depending on ejection fraction. At Stage D, care shifts to advanced options: specialized teams, devices, pumps, transplant evaluation. This describes usual practice, not a recommendation, your plan belongs to you and your cardiologist.
For trials, these labels double as eligibility language. Studies list "NYHA class II to III" or "LVEF 40% or below" right in the criteria, so knowing your ejection fraction, stage, and class lets you filter studies in minutes.
How to find a heart failure clinical trial
AllClinicalTrials.com lists heart failure studies recruiting across the US, from drug trials to exercise programs and device studies. A couple of examples recruiting right now: a Phase 3 trial testing maridebart cafraglutide in people with HFpEF and obesity, and the HEART Camp Connect exercise coaching program for people with HFpEF, no prescription involved.
The application takes about 5 minutes: you answer questions about your diagnosis, ejection fraction, and treatment history, and if a study near you looks like a match, the research team contacts you. Nothing is decided until you have gone through informed consent, and participation is voluntary at every step.
Three things to have ready before you start: your most recent ejection fraction, your NYHA class if you know it, and your current medicine list. Those three answers decide eligibility for most heart failure studies.
Common questions
What are the four pillars of heart failure treatment? For reduced ejection fraction: an ARNI or ACE inhibitor, a beta blocker, an MRA, and an SGLT2 inhibitor. Used together, they are called guideline directed medical therapy. Fewer than 1 in 4 eligible patients currently receive all four.
What is the newest treatment for heart failure? Finerenone (Kerendia), approved in July 2025 for heart failure with ejection fraction of 40% or higher. Before that, SGLT2 inhibitors became the first proven medicines for the preserved form in 2022 to 2023.
Is there treatment for heart failure with preserved ejection fraction? Yes, finally. SGLT2 inhibitors and finerenone are both approved, and weight loss medicines are being tested in large trials for people with HFpEF and obesity. Ten years ago none of this existed.
Can the heart recover from heart failure? In some people with the reduced form, ejection fraction improves substantially on modern therapy, which doctors call improved ejection fraction. It is not a cure, and treatment continues, but it is one of the reasons starting full therapy early matters.
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