A few years ago the patient with heart failure had an approximately prescribed course. The diagnosis of heart failure was synonymous with very severe disease, where the average survival of patients was about 3 ½ years. In other words, worse than cancer. But today things are completely different.

We now know how to treat heart failure. We aim at three different axes, which create the pathophysiological basis of the damage.

The first mechanism concerns the subclinical inflammation of the myocardium that dilates over years and destroys the myocardial fibers. After years of painstaking clinical studies, drugs that target subclinical inflammation, such as SGLT2 inhibitors (drugs known to be used for years by diabetic patients to improve their glycemic profile) have been found to improve the survival expectancy of heart patients.

The second mechanism concerns the neurohormonal axis, which is activated to save the myocardium but when its operation is prolonged, it is destructive for the heart. Thus, drugs such as ACE inhibitors, angiotensin antagonists, sacubitril-valsartan, and third-generation β-blockers along with MRAs have given patients longer and better quality of life.

Finally, the third mechanism concerns the reduction of the waste of the heart’s energy. We have known for several years that it is good to ensure the energy substrate and in recent years this has been achieved with the use of drugs such as beta-blockers.

It is true that the optimists believe that the doctor should not talk about the end or the final stage and this because even when it is still apparent that there are no reserves of the heart, there is a way to overcome the impasse.

In the age of galloping technology, a number of devices have been devised that support and rest the heart. Devices starting from the intra-aortic pump and reaching the latest type of pumps, which are implanted in the chest and operate with batteries, giving years to the patient. Also, new heart support devices that reduce the size and enhance the spasticity of the heart are in clinical trials with excellent results.

So it is true that a significant number of patients with heart failure recover remarkably. This is because, as the pump unloads the heart, it removes the extra burden of the volume of blood it is obliged to send to the vital organs of the body and allows the tired and fatigued myocardial cells to take over.

In this way we reduce the administration of diuretics that scourge the kidneys and create stimulation of the neurohormonal axis and chronic renal failure. Thus, the shape of the heart changes from spherical to ellipsoidal again, its valves work better, especially the mitral valve, and finally the extrusive force of the heart improves dramatically.

In many patients, the pump is removed after a few years and they live without a pump very satisfactorily. But even when that doesn’t happen, there is the heart transplant, so a new heart can be implanted into the chest and a new life can begin again.

A wind of optimism is beginning to blow for patients with heart failure, as we quickly believe that improvements in pumps and assistive devices will lead to the artificial heart, which may even solve the problem of the limited heart transplants available today.