Heart Failure

Treatment

Once the causes have been identified for your heart failure (when possible), your doctor will develop your treatment plan. Most often, this takes a management approach through medication and lifestyle changes. By carefully managing or eliminating risk factors and causes, you can improve the quality of your life and extend it for many years.

Spectrum of care

Your heart failure treatment will depend on the severity of your condition. Heart failure is a chronic, progressive disease for most people, and treatment will be adjusted to address the condition if it worsens over time. Doctors often refer to this as the spectrum of care: Medical treatment is available along a disease continuum, from mild to end-stage.

Doctors will recommend that adult patients with less advanced heart failure make lifestyle changes and will prescribe them medications to reduce the workload of the heart muscle. As the condition worsens, procedures, surgeries, the implantation of mechanical devices to assist the heart, or even a heart transplant may be required.

In children, treatment will be targeted at correcting congenital heart defects present at birth or treating other underlying causes. Since the mechanisms by which children develop heart failure differ from adults, lifestyle changes generally are not a focus of treatment in children.

Lifestyle changes

By making certain lifestyle changes, you can help reduce the burden on your heart muscle and help treat underlying conditions that contribute to heart failure.

1. Manage your blood pressure—Blood pressure is the force with which blood pumps against artery walls and is one of the leading causes of heart failure. If your blood pressure is too high, known as hypertension, the heart muscle has to work harder to pump against this pressure, and the force can damage the artery walls. If you’re unsure if you have high blood pressure, schedule a checkup with your doctor. If you already have high blood pressure, take any prescribed medications as directed.
2. Manage your diabetes—If you have diabetes, your body does not produce the insulin necessary to take glucose (sugar) from digested food and make it available to the body’s cells for energy. High blood sugar and inflammation caused by diabetes can damage the heart muscle and arteries, leading to a greater risk of heart failure. But by carefully managing your diabetes according to your doctor’s instructions, you can help prevent heart failure.
3. Quit smoking—Quitting smoking is one of the best things you can do for cardiovascular health. Smoking damages the lining of the arteries that carry blood throughout your body. The chemicals in cigarettes and other tobacco products can directly damage the heart muscle, contributing to heart failure. All forms of nicotine are harmful, including chewing tobacco and e-cigarettes, as is secondhand smoke exposure.
4. Eat a heart-healthy diet—If you’re unsure what to eat to be more heart-healthy, a dietitian can help you change your eating habits. For heart failure patients, it is usually important to reduce the amount of sodium or salt you eat and to lower your cholesterol. Managing your sodium intake is important because it can increase your blood pressure, one of the leading causes of heart failure. It can also cause fluid retention and higher blood volume, which places extra strain on the already weakened heart muscle and can interfere with the ability of prescribed diuretics to work effectively.

   Reduce Sodium
   • Consume less than 2,000 milligrams of sodium a day.
   • Check nutrition labels for sodium content.
   • Avoid salty snacks such as chips.
   • Keep an eye out for other sources of high sodium, such as soy sauce.
   Dietary cholesterol is one of the substances contributing to artery-clogging plaque buildup. This buildup occurs in arteries throughout the body and can contribute to coronary artery disease (CAD), heart attack, stroke, and peripheral artery disease. Both CAD and a prior heart attack can cause heart failure.

   Lower Cholesterol
   • Schedule a checkup with your doctor if you don't know your cholesterol level.
   • If you already know you have high cholesterol, work with your doctor to reduce levels.
   • Regular physical activity can lower blood pressure, help manage weight, and reduce stress—all of which can help manage heart failure—but what you take on should be tailored to your condition. For most people, the recommended physical activity is 30 minutes daily, five days a week. If you have heart failure, you may have to pace your activity because of fatigue—for example, doing three 10-minute walks daily is still 30 minutes of activity. Most doctors recommend doing an activity to your tolerance level, taking a break, and doing more later. It's important for you to check with your doctor about the type, duration, and intensity of exercise that would be the safest and most beneficial for you. 

5. Limit alcohol intake—Alcohol is a substantial contributor to heart failure. Alcohol can be a cardiotoxin, damaging the heart muscle if too much is consumed. Although some research suggests that light drinking may help heart health, don’t start drinking alcohol if you don’t already—doing so carries risks of alcohol dependence and other health problems.
6. Watch your weight—Obesity can contribute to high blood pressure, diabetes, coronary artery disease (CAD), and other factors that cause and worsen heart failure. Work with your healthcare team to manage your weight and cardiovascular health if you are overweight.

   In addition, you should weigh yourself daily, as rapid weight gain can be a sign of fluid retention. Contact your heart failure team if you notice a significant difference (2–3 pounds in one day or 5 pounds in one week). Catching worsening symptoms sooner rather than later may prevent hospital admission.

7. Join a cardiac rehabilitation program—Cardiac rehabilitation programs can help you resume a healthy lifestyle after a cardiac event, such as a heart attack, open-heart surgery, or angioplasty and stenting. Cardiac rehabilitation for heart failure has recently been approved for coverage under some care plans. You should consider participating in a cardiac rehabilitation program if you also need help making some lifestyle changes listed on this page, such as eating a heart-healthy diet and becoming more physically active.

Medications

If you have heart failure, your doctor will prescribe medications to help your heart function and to help reduce the workload of the heart muscle. It is important that you take any medications exactly as prescribed and report any side effects to your prescribing doctor. But do not stop taking your medication until you have been advised by your physician that it is safe to do so, as suddenly stopping any medication can be dangerous.

The most commonly prescribed medications for heart failure include the following:

• Aldosterone antagonists – These medications are diuretics that can also reverse damage to the heart and are prescribed for patients with certain types of severe heart failure.
• Angiotensin-converting enzyme (ACE) inhibitors – This class of medications lowers blood pressure by widening blood vessels and allows blood to flow more easily from the heart. The names of these medications often end in “-pril.”
• Angiotensin receptor blockers – These medications lower blood pressure and are used in patients who do not tolerate ACE inhibitors well. The names of these medications often end in “-sartan.”
• Beta-blockers – These medications lower blood pressure, slow the heart rate, and can improve the heart’s functioning. Beta-blockers can help improve the quality of life for heart failure patients and help them live longer. The names of these medications often end in “-olol.”
• Digoxin – This medication improves your heart’s pumping ability and slows an irregular heartbeat.
• Diuretics – Also known as “water pills,” diuretics cause you to urinate more often, preventing fluid buildup in your body. They also help to lower blood pressure.
• Inotropes – These medications are administered intravenously to improve heart functioning and blood pressure in cases of severe heart failure.
• Potassium – Important to your heart function, some heart failure medications can cause your potassium levels to drop. You should talk with your doctor before supplementing with potassium, as some heart failure medications can actually increase potassium, and you do not want too much in your system.
• Vasodilators – These medications relax blood vessels to lower blood pressure and reduce the workload of the heart muscle.

Procedures and surgeries

Depending on the severity of your heart failure, there are several procedures and surgeries available to help treat it, including the following:

• Heart transplant – This surgery, which may be necessary for end-stage heart failure, removes the heart muscle and replaces it with a deceased donor's heart. A fully mechanical heart has yet to replace the need for donor hearts.
• Implantable devices – These devices can assist the heart muscle in circulating blood throughout the body, thereby reducing the heart's workload and helping to prevent heart failure from worsening. These devices can lead to a longer, better quality of life for someone waiting for a heart transplant or for whom a transplant is not an option. In some cases, such as after a heart attack, these devices may even allow the heart muscle to rest enough to heal.
• Interventional procedures for congenital heart disease – For children born with heart defects caused by congenital heart disease, treatment can include interventional procedures that are delivered via a thin tube (catheter) inserted into a blood vessel and guided to the area that requires treatment.