How Heart Failure Is Treated

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Heart failure is a serious disease that cannot be cured. However, survival and quality of life with heart failure 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 commonly 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.

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

How to Treat Heart Failure

Theresa Chiechi / Verywell

Prescriptions

Prescription medications are the most effective treatments for management of heart failure. These medications often have to be adjusted periodically as the disease progresses. The optimal therapy of heart failure requires the combined use of several kinds of medications whenever possible. These include diuretic medication, an ACE inhibitor or an ARB (see below), and a beta blocker. Other kinds of medicine may also be necessary. Options include:

Beta Blockers

Beta blockers are used for heart failure because they slow down the heart rate. This allows the heart to fill more completely before pumping, which provides the body with more blood with each heartbeat. This helps alleviate some of the fatigue that you can experience as a result of heart failure. 

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 elimination of water and excess sodium from the body. This relieves the edema and shortness of breath of heart failure, as both of these symptoms are the result of fluid pressure in the body. 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 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 mechanism 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), 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 worsening of heart failure, which occurs when the heart pumps against high pressure for years. 

Neprilysin Inhibitors

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.

Entresto is still a relatively new treatment for heart failure, and its effect in comparison to the more established medications, as well as its long-term side effects, are not fully understood yet. 

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.

Dopamine shouldn't be taken with beta blockers, which lengthen and strengthen the normal effect of dopamine.

Lifestyle Changes

If you have heart failure, lifestyle adjustments are an absolutely necessary aspect of 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 on a daily basis. 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, and legumes.
  • 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 has been shown to help prevent and manage 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.

Always talk with your healthcare provider before starting a new exercise routine. They can tell you which activities and intensity level are safe for you. They might even suggest a cardiac rehab program.

Over-the-Counter 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 over-the-counter 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:

  • Non-steroidal anti-inflammatories (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 (Sudafed, Actifed, Contrex, and Nyquil) may also increase your blood pressure. 

A few over-the-counter 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 best to check with your healthcare provider before starting a new medication if you have heart failure.

Heart Failure Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Doctor Discussion Guide Old Man

Complementary Medicine (CAM)

Some complementary 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 adjustment have been shown to produce moderate benefit in heart failure. In general, there are a wide variety of stress management techniques, and it is important to select the approach that best fits your personality best.
  • Curcumin: A natural spice derived from turmeric, curcumin has shown some preliminary promise in heart failure in animals. Its effectiveness in preventing or treating heart failure in humans is unknown.

Complementary therapies should never be used in place of medical treatments recommended by your healthcare provider. Always tell your practitioner about any alternative or complementary treatments you're using.

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.

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 a major surgical procedure, 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 inhibits erratic electrical activity that causes heart rhythm abnormalities 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 address 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.

Frequently Asked Questions

  • What are the stages of heart failure?

    Many cardiologists rely on the New York Heart Association Functional Classification system for heart failure, which is based on the degree to which physical activity is limited by the condition:

    • Stage 1: No symptoms and no limits to activity
    • Stage 2: Mild symptoms and only minor limits to activity
    • Stage 3: Symptoms cause considerable limitations to activity, to the extent the person is comfortable only while resting
    • Stage 4: Physical activity is severely limited and symptoms are present even at rest
  • How long can you live with heart failure?

    An individual's prognosis after being diagnosed with heart failure will depend on a variety of factors, such as their age, how severe their condition is, and what has caused it. That said, the one-year survival rate for chronic heart disease is 80% to 90%; the five-year survival rate is 50% to 60%; and the ten-year survival rate is 30%.

  • Is it possible to recover from heart failure?

    No. But you may be able to prevent it from getting worse by watching your weight and diet, taking your medications, and following your cardiologist's instructions. In fact, some people with heart failure are able to raise a low ejection fraction—a measure of how well the heart is able to pump blood—as well as relieve symptoms by managing their condition properly.

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