How Is Heart Failure Treated?

Heart failure (HF) is a complex clinical syndrome resulting from a structural and/or functional problem with the heart that can limit its pumping action and affect its ability to fill with or eject blood. It is a condition that worsens over time. Many treatments can relieve symptoms and delay the progression of heart failure.^1,2

Heart failure has many causes, including diseases of the heart muscle, heart valves, blood vessels, or metabolic disorders. HF can be classified by changes in ejection fraction (EF):¹

• HF with reduced ejection fraction – Heart failure categorized by ventricular dysfunction. Also known as systolic HF or HFrEF.
• HF with preserved ejection fraction – Heart failure where EF is within the normal range. Also known as diastolic HF or HFpEF.

Treatment approaches

Treatment selection depends on the type, cause, symptoms, and severity of heart failure. Often, multiple therapies are used to achieve results.²

Specific conditions like high blood pressure and high cholesterol should be controlled according to established guidelines to lower HF risk. It is also important to prevent other health conditions that can affect HF like obesity and diabetes, and avoid poor habits such as smoking and the use of cardiotoxic agents.^3,4

Treatment goals

• To relieve symptoms
• To slow disease progression
• To improve the quality of life
• To help people live longer
• To decrease hospitalizations

Underlying medical causes

Part of the HF diagnostic process is to identify and treat any underlying medical conditions. Many people with heart failure also live with other medical conditions. In some cases when HF is caused by other medical conditions, it can be reversed with treatment of that condition. In most cases, HF worsens over time when left untreated, which requires coordinated and sometimes complex treatments to manage symptoms and extend life.²

Lifestyle

Lifestyle changes can improve or worsen heart failure symptoms. Treatment recommendations may include:^5,6

• Dietary changes, specifically a diet that is low in sodium
• Stopping smoking and avoiding exposure to second-hand smoke
• Limiting alcohol consumption
• Limiting caffeine intake
• Maintaining a healthy weight
• Exercising regularly according to medical recommendations
• Reducing stress
• Reporting sudden weight gain due to fluid build-up
• Tracking symptoms, such as shortness of breath or swelling, and reporting any changes to your doctor
• Getting regular medical checkups

Medications

There are many medications prescribed to treat heart failure. They may be prescribed to:⁵

• Dilate/relax blood vessels
• Strengthen the pumping ability of the heart
• Eliminate excess water and sodium in the body to decrease the workload of the heart

Surgery

There are also devices and surgical options to treat some causes of heart failure. They include:^2,7

• Implantable cardioverter defibrillator (ICD)
• Cardiac resynchronization therapy (CRT)
• Left ventricular assist device (LVAD)
• Coronary artery bypass
• Valve replacement
• Heart transplant

Ejection fraction

Ejection fraction is the most important determinant in the accurate diagnosis and treatment of HF. In cases of heart failure with reduced ejection fraction, the heart muscle is not able to contract with sufficient force and thus pumps less oxygen-rich blood out into the body.¹

Managing HFrEF involves treating the cause of HF and related medical conditions. It can include preventive steps, lifestyle modification, medications, ongoing monitoring, the use of medical devices to limit arrhythmias, and other care options up to and including a heart transplant. The first steps include limiting salt and fluid intake combined with medications and regular exercise.¹

Heart failure with preserved ejection fraction is becoming more common as it is related to aging and women are more than twice as likely to develop this kind of HF. Although the heart appears to contract normally, the thickened heart muscle reduces the volume of blood that the ventricle can hold. This decreases the amount of oxygenated blood ejected with each beat, causing symptoms.^8,9

Treatment aims to reduce symptoms and manage the underlying reasons for HFpEF. Blood pressure control, managing arrhythmias, preventing cardiac ischemia, and treating sleep apnea are some specific risk factors modifications that can decrease the severity of HFpEF.^3,8

There is no evidence-based treatment for heart failure with preserved ejection fraction, but new treatments are under investigation.⁹