Congestive heart failure (CHF), or simply heart failure, is a cardiovascular condition that affects the ability of the heart to work properly. Over time, the heart is unable to supply the rest of the body with enough oxygen-rich blood. This lack of oxygen-rich blood causes our body to compensate in a variety of ways, which can cause additional problems — kidney failure, heart rhythm problems, and blood clots.1
Congestive heart failure is a progressive disease, meaning it gets worse over time. It is also increasingly common among the aging population. In certain cases, congestive heart failure can be reversed, and heart function can improve with medications.
Your doctor may use a combination of medications, lifestyle changes, and/or surgery to address your symptoms. Fortunately, recent advancements in congestive heart failure treatment have helped people with this disease live longer, healthier lives.
Heart Failure Treatment
The treatment for congestive heart failure is quite complex and should involve your primary care doctor and specialists, ensuring quality of care over time. While heart failure can’t be cured, it can be managed with medications, living an active lifestyle, changes in your diet, and monitoring your weight.2
Heart Failure Staging
Factors that are considered when choosing medications for heart failure include your other health conditions and the severity of your heart failure. Your congestive heart failure status is classified using two staging systems created by the New York Heart Association (NYHA) and the American College of Cardiology/American Heart Association (ACC/AHA). Your doctor will use both to determine which treatment options are best for you based on your symptoms.3
Heart Failure Medications
Since CHF is a progressive disease and there’s currently no cure, you’ll likely have to take medication for the rest of your life. With that being said, many of the treatment options used in heart failure will help you live longer. The following medications are used to treat heart failure4:
ACE Inhibitors and ARBs
Some patients with heart failure have high blood pressure. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) work similarly to lower blood pressure by relaxing blood vessels and reducing stress on the heart. ACE inhibitors and ARBs are often used in the early stages of heart failure for patients with elevated blood pressure. It is important to note that higher doses of these medications reduce the risk of hospitalization from heart failure compared to lower doses in clinical trials. Therefore, each ACE inhibitor and ARB used for heart failure has a target dose.
Examples of ACE inhibitors include lisinopril (Zestril®, Prinivil®), enalapril (Vasotec®), and captopril (Capoten®). Valsartan (Diovan®) and losartan (Cozaar®) are commonly used ARBs. Both classes of medications are generally well tolerated, but you may experience fatigue, dizziness, and headache as side effects.
The most common side effect of ACE inhibitors is a dry cough that can be subtle and often unrecognized. If someone is experiencing a dry cough that is intolerable, the doctor may switch to an ARB.
Beta-Blockers
Beta-blockers are also often prescribed in the early stages of heart failure to help improve heart function. This benefit is due to beta-blockers slowing the heart rate and reducing blood pressure.
Beta-blockers that are commonly used to treat congestive heart failure are metoprolol (Lopressor®, Toprol-XL®), carvedilol (Coreg®), and bisoprolol. Studies show that these medications also help people with congestive heart failure live longer. When starting a beta-blocker, you may experience fatigue in the first few weeks — this side effect typically goes away once your body adjusts to the medication. Other side effects include dizziness and cold fingers and toes.
Diuretics
Diuretics are often referred to as “water pills” as they prevent fluid buildup in your body by eliminating sodium (salt) and water in the kidneys. This decrease in fluid buildup also occurs in the lungs, which helps you breathe more easily.
The most common diuretic used in congestive heart failure is furosemide (Lasix®). Diuretics can cause an increase in urinary frequency; because of this, doctors often recommend taking diuretics earlier in the day so that the increased urination doesn’t wake you up throughout the night. Some other side effects of furosemide include dizziness, headaches, and dry mouth.
ARNI
Entresto™ is a brand-name medication and the only angiotensin receptor-neprilysin inhibitor (ARNI) used to treat congestive heart failure. Entresto™ contains two drugs — valsartan and sacubitril. Sacubitril helps regulate the salt and water balance in the body, which can help reduce fluid buildup. Compared to enalapril (an ACE inhibitor) alone, Entresto™ has been shown to reduce the risk of hospitalization from congestive heart failure. Because Entresto™ is a brand-name medication, the cost is often a barrier. If your doctor does prescribe Entresto™, it is recommended to stop your ACE inhibitor 36 hours before starting Entresto™.
SGLT2 Inhibitors
Sodium-glucose cotransporter-2 inhibitors, or SGLT2 inhibitors, are a newer class of medications used to treat congestive heart failure. Studies show that SGLT2 inhibitors reduce the risk of hospitalization from congestive heart failure. These medications are commonly used to treat diabetes due to their ability to lower blood sugar, but they can be used for congestive heart failure alone. They’re especially useful for those who have both diabetes and heart failure. SGLT2 inhibitors that have been approved by the U.S. Food and Drug Administration (FDA) for use in congestive heart failure are empagliflozin (Jardiance®) and dapagliflozin (Farxiga®). SGLT2 inhibitors can cause dehydration and urinary tract infections.
Aldosterone Antagonists
Aldosterone antagonists are a class of medications that include spironolactone (Aldactone®) and eplerenone. Also considered potassium-sparing diuretics, these medications reduce fluid buildup and may help people with heart failure live longer. Spironolactone and eplerenone retain potassium, so routine monitoring of potassium levels is recommended — electrolyte changes are the main adverse effects. Spironolactone — unlike eplerenone — can cause gynecomastia (an increase in breast tissue), which is a significant difference between the two medications. However, eplerenone is often cost-prohibitive.
Vasodilators
Vasodilators facilitate blood flow and reduce blood pressure by expanding blood vessels. A combination of isosorbide dinitrate-hydralazine may be prescribed if you continue to have severe symptoms of CHF, even after trying other treatment options. The way in which hydralazine/isosorbide works is more complex than just by expanding blood vessels, but this is one of its key mechanisms.
Although this combination is generally prescribed separately in generic form, it is sometimes referred to as the brand name BiDil®. The most common side effects with this combination of medications are headache and dizziness.
Digoxin
Digoxin helps the heart beat stronger and may help alleviate symptoms of congestive heart failure. For those who also have atrial fibrillation (AFib), it may help slow their heart rate. Because of advancements in congestive heart failure treatment, digoxin is not prescribed as often today — however, if you are currently taking digoxin, your doctor may have you continue the medication to prevent worsening of your congestive heart failure symptoms.
Surgical Interventions
Surgery and medical devices may be necessary for some people to treat the problem that led to congestive heart failure and make your heart work properly.5
Coronary bypass surgery is performed when an individual has a blocked artery. The surgeon will reroute the blood to prevent the blocked artery from causing complications.
Heart valve repair or replacement can be performed if a valve in your heart is contributing to your heart failure.
An implanted device, medically referred to as an implantable cardioverter-defibrillator (ICD), monitors your heart and can act as a regulator to make sure it is beating properly.
Radiofrequency ablation, a procedure that uses radio waves to heat and destroy tissue in a very targeted way, may improve outcomes in patients with heart failure and atrial fibrillation.
A heart transplant is reserved as a last resort for those individuals with severe CHF when other treatment options have failed.
Living with Heart Failure
Living with a chronic condition like congestive heart failure can be very difficult. You don’t have to face this alone —- if you or a loved one have congestive heart failure, connecting with others who are in similar situations may help. One way to do that is to join an online community of people who are experiencing similar challenges with congestive heart failure.
Many people, including yourself, can make changes in their lives to stay healthy and feel better. There are several ways to make small changes that may make living with congestive heart failure just a little bit easier. By making these small changes, you can improve the quality of your life, control your condition, and limit the need for hospital care.
Lifestyle Changes for Congestive Heart Failure
While medications are vital to the treatment of congestive heart failure, lifestyle changes can also make a significant impact on how you live with your congestive heart failure. It is up to you to implement these changes.6
Quitting smoking is not easy, but support is available. Learn more about how to quit smoking.
Drinking too much alcohol may cause worsening congestive heart failure symptoms, but this is not always the case. Ask your doctor if any amount of alcohol is okay for you or if you should restrict or refrain from drinking alcohol.
Staying active is one of the best ways to stay healthy. Be sure to check with your doctor first before starting any activity.
Practicing good sleep habits is critical in getting quality sleep, which may provide better energy levels throughout the day. Because sleep disorders such as obstructive sleep apnea are very common in heart failure patients, treating any sleep disorder directly can help greatly.
Managing Symptoms of Congestive Heart Failure
An important aspect of managing congestive heart failure is ensuring that other chronic diseases are well controlled, which can help lower stress on the heart and slow the progression of heart failure. These can include hypertension (high blood pressure), lipid disorders (high cholesterol), obesity, and diabetes.
Additionally, the following lifestyle changes can directly impact the management of CHF7:
- Monitoring weight fluctuations lets you and your doctor know if your body is retaining fluid. Notifying your doctor about significant weight changes may prevent complications from heart failure.
- Because sodium causes your body to retain water, your doctor may recommend that you restrict your sodium intake.
- Drinking too many fluids throughout the day can cause worsening of your CHF symptoms. Your doctor may recommend fluid restriction based on your symptoms.
- Certain medications can cause you to retain water, especially non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil®, Motrin®). Ask your doctor if you should avoid taking NSAIDs or any other medications that cause water retention.
The Future of Heart Failure Treatments
Healthcare has witnessed significant advancements in the treatment of congestive heart failure over the past few decades, and researchers continue to develop new and improved treatment options for people suffering from congestive heart failure. One of the key reasons why these advancements have been successful is that individuals are willing to participate in clinical trials to study these interventions. Participation contributes to medical research and gives people access to new research treatments before they are widely available. The most recent advancements in the treatment of heart failure include:
- SGLT2 inhibitors, including empagliflozin (Jardiance®)8 and dapagliflozin (Farxiga®)9
- Verquvo®, which was recently approved by the FDA based on data showing fewer hospitalizations and congestive heart failure-related deaths in people who took this once-daily medication
With the technology of the 21st century, healthcare is expecting to see therapies with advanced implantable devices become incorporated more often into the medical management of heart failure.10
