Heart failure (sometimes called congestive heart failure) can’t be cured. However, treatment, along with early diagnosis, can improve quality and length of life for people who have the condition, per the CDC. Treatment can also help improve symptoms of heart failure, which include shortness of breath, weight gain or swelling in the feet, legs, ankles, or abdomen, and fatigue, notes the American Heart Association (AHA). RELATED: How to Live Longer With Congestive Heart Failure “Heart failure [treatment] is generally divided between people who have an ejection fraction less or more than 40 percent,” said J. Emanuel Finet, MD, a cardiologist at Cleveland Clinic. An ejection fraction (EF) below 40 percent means your heart is not pumping enough blood and may be failing, according to Penn Medicine. Generally speaking, the following treatments and interventions are available for individuals with an EF less than 40 percent, explains Dr. Finet.
Medications for Heart Failure
After a diagnosis of heart failure, multiple medications may be needed, according to the AHA. The following drugs may be prescribed to help decrease symptoms, improve heart function, and in many cases prolong your life:
Angiotensin-converting enzyme (ACE) inhibitors widen blood vessels to lower blood pressure, improve blood flow, and reduce the workload on the heart. Commonly prescribed ACE inhibitors are captopril, enalapril, fosinopril, lisinopril, perindopril, quinapril, ramipril, and trandolapril.Angiotensin 2 receptor blockers, also known as ARBs, prevent blood pressure from rising. They are used as an alternative to ACE inhibitors if they can’t be tolerated. Commonly prescribed ARBs are candesartan, losartan, and valsartan.Beta-blockers slow your heart rate and force of contractions, which reduces blood pressure and makes the heart beat more slowly and less forcefully. Commonly prescribed beta-blockers are bisoprolol, metoprolol succinate, carvedilol, and carvedilol CR.I(f) channel blockers (or inhibitors) reduce heart rate, similar to beta-blockers. Commonly prescribed If channel blockers include ivabradine (Corlanor).Aldosterone antagonists are potassium-sparing diuretics that help the body get rid of excess water to reduce blood pressure. Commonly prescribed aldosterone antagonists are spironolactone and eplerenone.Angiotensin receptor neprilysin inhibitors (ARNIs) are a combination drug consisting of a neprilysin inhibitor (sacubitril) and an ARB. Inhibition of neprilysin improves artery opening and blood flow, reduces sodium retention, and decreases strain on the heart, per the AHA. Sacubitril is a commonly prescribed ARNI.Hydralazine and isosorbide dinitrate (combination drug) is specifically beneficial for Black Americans with heart failure.Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have recently been recommended as a fourth class of medication for people with heart failure with reduced ejection fraction. SGLT2 inhibitors lower blood sugar by preventing the kidneys from reabsorbing glucose back into the blood.
Additionally, the following drugs can help in the management of heart failure symptoms, but they won’t treat heart failure itself, explains Finet:
Diuretics, also known as water pills, reduce the amount of fluid in the body, relieving some of the heart’s workload. Commonly prescribed diuretics include furosemide, bumetanide, torsemide, chlorothiazide, amiloride, hydrochlorothiazide, indapamide, metolazone, and triamterene.Statins, or cholesterol-lowering drugs, are often prescribed for the secondary and primary prevention of atherosclerotic cardiovascular disease.Digoxin is used in some cases to treat abnormal heart rhythms (arrhythmias).
Exercise and Eat Right for Heart Health
Making healthier lifestyle choices is often recommended for heart health. A review published in December 2021 in Nutrients found that the DASH diet, which limits salt, fatty meats, added sugar, and full-fat dairy products, can have a positive impact on heart failure patients. Additionally, weight reduction was found to improve cardiac function, alleviate symptoms, and potentially improve heart failure hospitalizations. But weight loss doesn’t come from diet alone. Exercise is often needed to reduce pounds. A review published in April 2018 in ESC Heart Failure found that exercise was helpful at all stages of heart failure. Exercise helps prevent heart failure before it happens, and despite earlier research, is an adequate recovery tactic after experiencing heart failure. Benefits include strengthening the heart and cardiovascular system, improving blood flow, and increasing energy levels. According to Cleveland Clinic, some guidelines to exercise for people with heart failure include:
Walk a moderate pace for about 5 to 10 minutes, slowly increasing each day until you walk 30 to 45 minutes.Rest when needed, but try not to lie down when you are finished working out.If you don’t like walking, other aerobic activities like cycling, swimming, or rowing are good alternatives.Stop your exercise and notify your doctor If you have excessive shortness of breath, a rapid heart rate that does not resolve after 15 minutes of rest, dizziness, or chest discomfort.
In addition to exercise and weight loss or maintenance, the following lifestyle habits can improve heart failure symptoms and slow the progression of disease, per the AHA.
Quit smokingTrack your fluid intake (and possibly limit fluids)Avoid or limit alcoholAvoid or limit caffeineEat a heart-healthy diet (and reduce sodium)Reduce stressMonitor and control high blood pressureGet adequate rest and sleepJoin a support groupCheck your legs, ankles, and feet for swelling dailyStay up to date on recommended vaccinations
Ask Your Doctor if Surgery Will Help
While surgery isn’t often used to treat heart failure, it may be recommended if your condition can’t be helped with medication or dietary and lifestyle changes, or if your doctor believes that is the only way to treat your condition — if you have a diseased heart valve or a blocked coronary artery, for example. “One of the causes of heart failure is ischemia,” said Robert P. Davis, MD, assistant professor of cardiac surgery at Yale School of Medicine in New Haven, Connecticut. “Opening up blood vessels with angioplasty technique or coronary artery bypass surgery is a treatment option for people with heart failure and sometimes if you reverse the ischemia, this can relieve their heart failure symptoms.” Angioplasty, also called percutaneous coronary intervention, is a catheter-based procedure that reopens blocked blood vessels, according to the AHA. During angioplasty, a catheter with a small balloon-like device is threaded through a vein and opened once it reaches the clogged artery. Then a small wire tube (called a stent) may be placed into the artery to keep it open. There is a slight risk of damage to the artery during this procedure, but angioplasty usually improves the condition. Meanwhile, coronary bypass surgery requires surgeons to utilize healthy blood vessels from another part of your body, such as a leg or the chest wall, and then attach the vessels to your diseased artery so the blood can flow around the blocked section, per the AHA. Coronary bypass surgery is one of the most common types of heart surgery that is performed, according to Dr. Davis. Some more serious cases of heart failure may qualify a patient for heart valve replacement or in extreme cases, a heart transplant. A heart valve replacement is needed when one of your heart valves is diseased or defective which can lead to extra strain on the heart and then heart failure. A variety of replacement valves can be used, including those made from metal and plastic and those made from human or animal tissue. The surgery involves the patient being connected to a heart-lung machine while the bad valve is removed or replaced. A heart transplant is for the most dire circumstances. “We refer to this as end-stage heart failure,” said Davis. “We’ve exhausted all treatment options.” During a heart transplant, the surgeon connects you to a heart-lung machine, which takes over the functions of the heart and lungs while the damaged heart is replaced with a healthy one taken from a donor. Then the major blood vessels are reconnected, and the new heart begins working. According to the AHA, about 90 percent of people live for more than a year after receiving a heart transplant. But it can take several months to find a donor heart that is a good match. In fact, the AHA reports that only around 2,500 people receive a transplant each year. Finally, these implanted devices are recommended by the AHA to help improve heart function or protect against sudden cardiac arrest for some people with heart failure:
Biventricular pacing, or cardiac resynchronization therapy, is a pacemaker that makes the ventricles contract more normally and in synchrony.An implantable cardioverter defibrillator (ICD) is a surgically placed device used in some people who have severe heart failure or serious arrhythmias. The device delivers an electric counter-shock to the heart when a life-threatening abnormal rhythm is detected.Left ventricular assist devices (LVADs) are battery-operated, pump-like devices that are surgically implanted to help maintain the pumping ability of the heart.
