Heart failure is a lifelong condition that needs to be managed. There are a number of treatment options, which will ultimately depend on:
- The underlying reason for the heart failure – for example, if you had a prior heart attack, or have high blood pressure or a valve problem.
- Your type of heart failure – often based on your ejection fraction (normal vs. low).
- How severe your heart failure is; there is a very wide range of severity from very mild to extremely severe. This is estimated based on your symptoms.
- Other existing conditions such as your kidney function.
Lifestyle Changes
When you live with heart failure, you must take steps to make your health a priority. Adopting healthier habits can help support you heart health. That means finding ways to:
- Eat low salt, low-fat foods
- Exercise regularly
- Not smoke
- Lose weight if you need to
- Monitor your fluid intake (ask how much water or fluid you can drink each day)
- Keep other conditions in check – many people with heart failure also have other health issues such as high blood pressure, diabetes, or chronic obstructive pulmonary disease
Cardiac Rehabilitation
Cardiac rehabilitation provides you with a supervised exercise program that’s geared toward your fitness level and health needs. It also provides a support system to help you adopt lifelong healthy behaviors and monitor your progress.
Cardiac rehab is approved for some patients living with heart failure. Participating in this program can help you feel better, make your heart stronger and may reduce your need to go to the hospital.
Medications
Medications are an important part of treating heart failure. Your doctor may recommend one or a combination of the following:
Angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) relax your blood vessels and reduce strain on your heart and improve blood flow. They also lower blood pressure.
Angiotensin receptor-neprilysin inhibitor (ARNI) is a combination of an ARB and a medicine that inhibits the production of neprilysin, an enzyme. This enzyme breaks down natural substances in the body that widen blood vessels and reduce sodium retention. The effect is to lower blood pressure and decrease strain on the heart.
Beta blockers can slow a rapid heart rate and lower your blood pressure.
Digoxin slows heart rate and strengthens heart muscle contractions to pump more blood. It can make you feel better.
Diuretics, also called water or fluid pills, help keep fluid from building up in your body or lungs – they will also make you urinate more often.
Mineralocorticoid receptor antagonists help the body to get rid of salt and water through urine. This lowers the volume of blood that the heart must pump.
Nitrates and hydralazine is a combination of drugs that has been shown to improve outcomes in African American patients. It is often used if someone is allergic to or can’t take ACE inhibitors or ARBs.
Sinoatrial node modulator (ivabradine) is a drug used with beta blockers when they cannot lower your heart rate enough. It helps reduce the amount of oxygen your heart needs and the amount of work your heart does to pump blood through the body.
Sodium-glucose cotransporter 2 (SGLT2) inhibitors were originally used to treat diabetes. These medicines have clear benefits for people with heart failure, including fewer heart-related deaths and hospitalizations.
Soluble guanylase cyclase stimulator (vericiguat) can result in beneficial relaxation of blood vessels and decrease strain on the heart. This medication may result in fewer heart-related deaths and hospitalizations in people with heart failure who have recently been hospitalized and are already on optimal medical therapy with ARNI, beta blockers, aldosterone antagonists, and SGLT2 inhibitors.
Choosing Heart Failure Drugs
About half of patients with heart failure (HF) have a weak heart. These patients have been shown to live longer and feel better if they take a drug that stops the renin-angiotensin hormone pathway.
Some of these medicines have been around for a long time, work well, and are available as generics with low cost to patients.
A newer medicine has been shown to work better than the older medicines in patients with HFrEF, or heart failure with reduced ejection fraction, but it tends to come at a higher cost. Ejection fraction is a measure of how well your heart is pumping.
If you have HFrEF and are trying to decide which medicine to take to stop the renin-angiotensin hormone pathway, use this four-page decision aid to better understand your options. Then decide with your doctor or a member of your care team what treatment is right for you.
Devices
Many people with heart failure also have a problem with the way their heart beats (arrhythmia). Many patients with a low ejection fraction—when the amount of blood the heart is able to squeeze out is much less than what it normally would be—may benefit from small electric devices implanted in the chest, just under the skin, with wires going to the heart.
These devices can be useful to prevent sudden cardiac death or help the heart beat in a more coordinated manner in select patients.
- Implantable cardioverter defibrillator (ICD) – a battery-powered device that keeps track of your heart rate and releases an electric shock if it detects a dangerously fast heart rate, resetting the heart rhythm
- Cardiac resynchronization therapy (CRT) – this small device is implanted just below the collarbone. It sends electric signals to the lower chambers of the heart so that they beat together in a more synchronized way, helping the heart to pump better.
Studies show that these devices can help improve quality of life and may prolong survival in properly selected patients.
For very late stages of the disease, a person may need a left ventricular assist device—a mechanical heart pump—to help the heart move blood through the body. This is often used in individuals who are awaiting a heart transplant.