Serelaxin in the Treatment of Acute Heart Failure in the Emergency Department

Purpose of the Review The aim of this paper is to review the historical perspective for the need for new agents in the treatment of acute heart failure that may impact morbidity and mortality. Also, the purpose is to introduce serelaxin and discuss how it may play a role in the treatment for acute heart failure, in particular in the emergency department. Recent Findings Prospective, randomized trials in acute heart failure are limited. No single intervention or treatment in acute heart failure has improved mortality. However, registry data show that rapid treatment for acute heart failure produces better outcomes. Serelaxin is a pharmaceutical analog of relaxin which is a naturally occurring peptide hormone released in pregnancy that helps regulate hemodynamic function and renovascular blood flow through a number of effects including stimulation of nitric oxide production, vascular endothelial growth factor, and matrix metalloproteinases, and inhibition of endogenous vasoconstrictors. Serelaxin improved mortality at 180 days in RELAX-AHF when patients received 48 h of intravenous serelaxin within hours after presentation to the emergency department. Summary Serelaxin is a new agent with a different mechanism of action than previous agents studied in the treatment of acute heart failure. It produces vasodilation and improved renovascular blood flow and may prevent end organ damage to improve outcomes in patients with acute heart failure. Rapid treatment in the emergency department with intravenous diuretics and serelaxin in appropriate patients with normal to high blood pressure may have a beneficial effect on patients with acute heart failure.