How Heart Failure Is Treated

Heart failure is a serious disease that impacts over 30 million U.S. adults, causing death in over 650,000 people per year. Most types of heart failure are preventable by living a healthy lifestyle that includes eating a low-sodium diet that is high in fruits and vegetables and adopting a regular exercise routine. 

The most common type of heart failure (the type most healthcare providers and diagnosed people mean when they refer to the term "heart failure") is caused by a progressive weakening of the heart muscle.

The conditions that most often lead to this kind of heart failure include coronary artery disease (damage or diseased vessels supplying blood to your heart), high blood pressure (force of blood against artery walls is too high), and type 2 diabetes (inability of your body to regulate blood sugar).

Heart failure usually occurs in people over the age of 65 and is slightly more common in men than women. Black Americans, people who are overweight, and those with a prior history of heart attack are at higher risk of heart failure. 

Heart disease cannot be cured, but survival and quality of life with heart failure can be improved with medical treatment, lifestyle modifications and, sometimes, with specialized surgical procedures.

Prescription medications, such as beta-blockers, ACE inhibitors, and diuretics, are common approaches to heart failure treatment. These drugs work by stimulating the heart to pump more efficiently, preventing excess fluid from building up in the body and lowering blood pressure. Other medications may be recommended —depending on the severity of the disease.

When medications aren't enough to manage symptoms, or when a problem like an arrhythmia or heart valve disease is the cause of heart failure, procedures such as valve replacement, a pacemaker, or other interventions may be necessary for some people.

This article will review the common medications and other treatment options that are commonly used in the management of heart failure.

Man contemplating his meds

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What Medications Are Used for Heart Failure?

Prescription medications are the most effective treatments for the management of heart failure. These medications often have to be adjusted periodically as the disease progresses.

The optimal therapy of heart failure typically requires the combined use of several kinds of medications whenever possible. Options that may be used include:

Beta-Blockers

Beta-blockers are used for heart failure because they slow down your heart rate. This allows the heart to fill more completely before pumping, which provides the body with more blood with each heartbeat. This process helps alleviate some of the fatigue that you can experience as a result of heart failure. It is important for people starting this therapy to know that, due to the decrease in heart rate, it's very common to feel worse before feeling better. It will take the heart and body some time to adjust to the new lower heart rate, and you may feel excessively tired, sluggish, or dizzy for the first few days. 

Examples include:

  • Coreg (carvedilol)
  • Inderol (propranolol)
  • Sectral (acebutolol)
  • Tenormin (atenolol)
  • Toprol (metoprolol)
  • Zebeta (bisoprolol)

Diuretics

Diuretics are medications that act on the kidneys and promote the elimination of water and excess sodium from the body. This relieves the edema (fluid overload) and shortness of breath that can be symptoms of heart failure. Potassium levels can become low with diuretic use, so mineral supplementation may be required.

Commonly used diuretics include:

  • Bumex (bumetanide)
  • Diuril (chlorothiazide)
  • Demadex (torsemide)
  • Esidrix (hydrochlorothiazide)
  • Lasix (furosemide)

Angiotensin-Converting Enzyme (ACE) Inhibitors

These medications work to relax the blood vessels of the body in order to lower the pressure that your heart has to pump against. The most common ACE inhibitors used in heart failure include:

Angiotensin II Receptor Blockers (ARBs)

ARBs also work by lowering blood pressure, which reduces the strain on the heart. They are similar to ACE inhibitors in how they work and effectiveness but have fewer side effects. Examples of ARBs include:

  • Atacand (candesartan)
  • Benicar (olmesartan)
  • Cozaar (losartan)
  • Diovan (valsartan)
  • Micardis (telmisartan)

Aldosterone Antagonists

Aldosterone antagonists, such as Aldactone (spironolactone) and eplerenone, block the action of a hormone called aldosterone and remove fluid from the body. They are known as "potassium-sparing," because they prevent the potassium level in the body from becoming too low.

Hydralazine

Hydralazine in combination with nitrates works to dilate (expand) arteries, lowering blood pressure. This prevents the worsening of heart failure, which occurs when the heart pumps against high pressure for years. 

Angiotensin-Receptor Neprilysin Inhibitors (ARNIs)

Entresto is a combination of valsartan, an ARB inhibitor, and a new agent called sacubitril. Sacubitril inhibits the enzyme neprilysin, causing an increase in levels of natriuretic peptides, which help regulate blood pressure, as well as salt and fluid levels.

SGLT-2 Inhibitors

Jardiance (empagliflozin) is a sodium-glucose co-transporter 2 (SGLT2) inhibitor, which was initially prescribed to lower blood sugar and reduce the risk of cardiovascular death in adults with type 2 diabetes. However, it is now approved and recommended for adults with heart failure (regardless of injection fraction) to reduce the risk of cardiovascular death and hospitalization due to heart and blood vessel disease.

Dopamine

By making the heart beat more forcefully, dopamine helps it circulate oxygen-rich blood more efficiently. Dopamine also increases the amount of urine the body produces, which helps the body get rid of the extra fluid building up in the lungs, arms, and legs. 

Interestingly, unlike many of the other medications used for heart failure that lower blood pressure, dopamine raises blood pressure. In some circumstances, this effect is helpful because low blood pressure may occur in heart failure.

Dopamine is an intravenous drug and isn't usually the first treatment choice for heart failure, but it is especially useful in premature babies and infants with other heart problems. It can boost babies' heart rates and blood pressure, significantly improving their chances of survival.

Other Heart Failure Medications

Heart failure is a complex condition that may require the use of older classes of drugs aimed at lessening your symptoms. The following drugs may be used on a case-by-case basis if you are experiencing worsening symptoms that are not getting better with the aforementioned medications:

  • Lanoxin (digoxin): Digoxin, also called digitalis, is used to help a weak heart pump more efficiently. Digoxin strengthens the force of the heart muscle's contractions and, in low doses, helps restore a normal, steady heart rhythm. Some cardiologists (doctors who specialize in heart disorders) have been reluctant to prescribe digoxin because long-term use can cause arrhythmias.
  • Vasodilators: Vasodilators are a mainstay in the management of acute heart failure, particularly when accompanied by high blood pressure. Vasodilators promote the forward flow of blood by widening blood vessels, thereby reducing tension. Currently, available medications include Rectiv, Nitro-Time, Nitrolingual (nitroglycerin), Nitropress (nitroprusside), and Natrecor (nesiritide).
  • Calcium channel blockers (CCB): CCBs may be used in acute heart failure due to high blood pressure when other blood pressure medications are not effective. Of note, they should be avoided in people with heart failure and reduced ejection fraction (HFrEF).
  • Statins: Statins are cholesterol-lowering drugs (medications that reduce the waxy, fatty substances in blood) that may reduce your risk of coronary artery disease, a major risk factor of heart failure. The higher your baseline low-density lipoprotein (LDL) levels are, the higher your risk is of experiencing a cardiovascular event (such as a heart attack or stroke). Therefore, the strength and type of statin you take will depend on the severity of your hyperlipidemia (blood with too many lipids, or fats) and how your body responds to the medication. Statins are not recommended solely for the treatment of heart failure.
  • Blood thinners: Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) with the ability to prevent blood clotting, or blood thinning. Historically a low dose (an 81 milligram dose called baby aspirin) has been recommended to reduce the risk of heart attack and stroke in high-risk people, but the efficacy of this practice has been questioned in recent reports. 
  • Nitrates: Nitrates are a type of vasodilator used in the treatment of acute heart failure. Nitrates work by decreasing left ventricular filling pressure (pressure on the left side of the heart) and systemic vascular resistance (the pressure that counters blood flow), while also modestly improving the amount of blood pumped by the heart (cardiac output).

Lifestyle Changes

If you have heart failure, lifestyle adjustments are an absolute necessity for managing your condition. While these changes cannot cure heart failure, they can help improve your quality of life. Not following these lifestyle recommendations is associated with worsening of the symptoms of heart failure and progression of the disease itself. 

Reducing Salt

Eating salt causes the body to retain more fluid. This is not a problem for healthy people, as the body can rebalance and eliminate any excess fluid and salt fairly efficiently.

However, if you have heart failure or kidney disease, this doesn't happen as efficiently as it should—increasing your chances of fluid accumulation. Many people with heart failure notice that symptoms of swelling and shortness of breath worsen with an increased salt intake.

The American Heart Association recommends an ideal limit of 1,500 milligrams of sodium per day for most people, but ask your healthcare provider or dietitian how much salt you can consume daily. The best ways to cut salt intake include avoiding canned or processed foods and not using table salt.

Healthy Diet

A heart-healthy diet is also important for preventing heart failure from developing or getting worse, because coronary artery disease (CAD) is a major contributor to heart failure. You should avoid excess cholesterol and fat (especially trans fat), and instead base your diet mostly on whole, unprocessed foods.

Keys to a Heart-Healthy Diet

  • Eat plenty of fruits and vegetables.
  • Choose whole grains rather than refined ones.
  • Limit red meat, and instead get your protein from fish, lean poultry (including skinless white-meat chicken and turkey), and legumes (including lentils, peas, and beans).
  • Avoid added sugars.
  • Choose low-fat or nonfat dairy products.
  • Get healthy fats from sources like nuts, avocados, and olive oil.

Watching Weight

Maintaining a healthy weight helps protect your heart from the burden of having to pump blood to support a heavier body—a concern, as a strain on the heart is already a problem in heart failure. To lose weight successfully, you may need advice from a dietitian, who can evaluate your diet to see if you should cut back on carbohydrates, fat, or calories in general. 

For some people, weight-loss surgery is an option when diet and exercise aren't enough to lose weight. Bariatric surgery (making changes to your digestive system, such as with gastric bypass or gastric band surgeries) has been shown to help prevent and manage heart failure.

 Can Weight-Loss Surgery Help Avoid Heart Failure?

Physical Activity

Staying active is important for everybody, but for people with heart failure especially, it can keep your heart muscle strong. Over time, it can help make the heart work more efficiently, reducing heart rate and blood pressure. It can also boost your stamina and improve your breathing.

Exercise may not be easy for everyone with heart failure, so you should be careful to avoid overexertion. Walking is an ideal activity for most people. Remember to slow down or take a break if you ever feel too short of breath, or if you feel dizzy or faint.

Over-the-Counter (OTC) Therapies

Over-the-counter medications are not normally beneficial in heart failure. In fact, a number of them can cause heart failure to worsen. Some can also interfere with prescription heart failure medications, preventing them from working as they should.

If you have heart failure, it is best not to use OTC drugs, even for routine health problems, without checking with your healthcare provider or pharmacist first. 

Some of the most common over-the-counter medications you should avoid if you have heart failure include:

  • NSAIDs: Drugs such as aspirin, Advil or Motrin (ibuprofen), and Aleve or Naprosyn (naproxen) can cause an increase in your blood pressure. 
  • Cough medications containing pseudoephedrine: Drugs such as Sudafed, Actifed, Contrex, and Nyquil may also increase your blood pressure. 

A few OTC medications that are considered safe to take if you have heart failure include:

  • Chlortrimeton or Aller-Chlor (chlorpheniramine), an antihistamine used for allergies and colds
  • Claritin (loratadine), a non-drowsy allergy medicine
  • Robitussin DM (guaifenesin with dextromethorphan), a cough medication
  • Tylenol (acetaminophen), a pain reliever

But again, it's always important to check with your healthcare provider before starting a new medication if you have heart failure.

Complementary and Alternative Medicine (CAM)

Some complementary and alternative medicine therapies have been proven to show benefit in the management of heart failure. These approaches do not cure or improve the condition, and they have not been proven to prolong life. However, they may improve symptoms and help in preventing the worsening of heart failure. 

  • Mind-body interventions: Techniques such as yoga, tai-chi, acupuncture, biofeedback, and reflexology are generally done with the guidance and supervision of a trained expert. Studies have shown that these interventions can provide small to moderate benefits for people who have heart failure.
  • Stress reduction: Stress management techniques such as meditation, counseling, mindfulness, and lifestyle adjustments have been shown to produce moderate benefit in heart failure. In general, there is a wide variety of stress management techniques, and it is important to select the approach that best fits your personality best.
  • Curcumin: A compound from the spice turmeric, curcumin has shown some promise in early studies of heart failure in animals. Its effectiveness in preventing or treating heart failure in humans is unknown.

Procedures

Surgery or other procedures do not cure heart failure itself. They can, however, improve heart function, regulate an irregular heart rhythm, or repair a heart valve abnormality, which may be appropriate and beneficial in some—though not all—people with this condition.

Defibrillator

An implantable defibrillator is a pacemaker-like device that is used to prevent sudden death in people who are at high risk for this event. If a dangerous arrhythmia occurs, the implantable defibrillator can automatically deliver a shock to the heart to restore the rhythm back to normal.

Cardiac Resynchronization Therapy (CRT)

A CRT device is a specialized pacemaker that can coordinate the pumping action of the heart's right and left ventricles, to improve the efficiency of the heartbeat. CRT can be useful in selected people with heart failure who also have certain kinds of bundle branch block (a delay or obstruction in electrical impulses traveling to your heart to make it beat).

Implantation of a defibrillator or CRT device may take place in the operating room or in a specialized cardiac suite in the hospital. They are usually done under local anesthesia and are typically tolerated well. Most people stay in the hospital for observation for about 24 hours. 

Left Ventricular Assistive Device (LVAD)

LVADs are battery-operated pumps implanted in the body to assist the heart with pumping. They were initially considered a way to support the heart function for people who were waiting for heart transplants, but they are effective and can be used as a more long-term plan.

Placement of these devices requires general anesthesia and a recovery period of several days. You should also expect your medical team to test the effectiveness of the device shortly after the procedure and periodically for the long term.

Heart Transplant

A heart transplant is a procedure in which your heart is surgically removed and completely replaced with a donor's heart. This is major surgery, requiring general anesthesia and intense monitoring during surgery. You should expect close monitoring after surgery, several weeks of recovery, as well as a plan for cardiac rehabilitation after your transplant. 

Catheter Ablation

A catheter ablation is a procedure that tries to prevent erratic electrical activity that causes heart rhythm abnormalities. It does this by destroying or interrupting the area responsible for the problems. You might benefit from this procedure if you have an irregular heart rhythm. 

You may have the procedure in the operating room or in a specialized cardiac procedural suite in the hospital. You can expect a relatively quick recovery if your procedure is uncomplicated. 

Valve replacement

A replacement heart valve can help with blood flow restriction due to abnormal valve structure. This may be a routine procedure, or it may be quite extensive, depending on the severity of the valve problem and how many valves are affected.

A heart valve replacement uses either an artificial valve or one composed of human or pig tissue. Which type of heart valve replacement is best for you depends on your anatomical heart valve problem and your personal preferences.

Summary

Although there is no cure for heart disease, survival and quality of life can be improved with medical treatment, lifestyle modification, and, sometimes, with specialized surgical procedures.

Prescription medications, such as beta-blockers, ACE inhibitors, and diuretics, are the most used approaches to heart failure treatment. These drugs work by stimulating the heart to pump more efficiently, preventing excess fluid from building up in the body, or by lowering blood pressure.

A Word From Verywell

Heart failure is a complex disease that requires a personalized approach. Taking prescription medications to improve your symptoms and help your heart pump more efficiently is just one part of a thorough treatment plan. Understanding how these medications work and the potential side effects is key to figuring out the best treatment plan that works for you. 

Frequently Asked Questions

  • What is the best medication for heart failure?

    Heart failure is a complex condition. No two cases of heart failure are the same. Treatment needs to be fine-tuned to your particular conditon. Diuretics and beta blockers are mainstays of therapy that are commonly used to lessen acute symptoms. 

  • What is the first line treatment for heart failure?

    Angiotensin-converting enzyme (ACE) inhibitors and beta-blockers are first-line therapies for most people with acute heart failure. Other first-line therapies for heart failure with reduced ejection fraction include ARBs, ARNIs, aldosterone antagonists, and SGLT2 inhibitors—as they have been shown to decrease morbidity and mortality.

  • What is the latest drug for heart failure?

    Jardiance (empagliflozin). It was originally approved by the Food and Drug Administration (FDA) in 2014 as a supplement to diet and exercise to improve glucose control in adults with type 2 diabetes. Jardiance is also approved to reduce the risk of cardiovascular death in adults with type 2 diabetes and established cardiovascular disease, and to reduce the risk of death and hospitalization in patients with heart failure (regardless of ejection fraction).

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