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How Is Heart Failure Treated?

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

Heart failure has many causes including diseases of the heart muscle, heart valves, blood vessels, or metabolic disorders. HF can be categorized by changes in ejection fraction (EF). Ventricular dysfunction can cause HF with reduced ejection fraction known as HFrEF or systolic HF; or HF with preserved ejection fraction, HFpEF, or diastolic HF.1

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 such as hypertension and high cholesterol should be controlled in accordance with established guidelines to lower HF risk. Other comorbid conditions that can affect HF including obesity, diabetes, smoking, and cardiotoxic agents, should be limited or avoided.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 have comorbidities, multiple medical conditions present in one person. In some cases when HF is caused by other medical conditions, it can be reversed with treatment of that condition.2 More commonly HF progresses requiring coordinated and sometimes complex treatments to manage symptoms and extend life.

Lifestyle

Lifestyle changes can improve or exacerbate (worsen) heart failure symptoms. Treatment recommendations can include:5-6

Medications

There are many medications prescribed to treat heart failure, all of which have different functions. They may be prescribed to dilate/relax blood vessels, strengthen the pumping ability of the heart, and to eliminate excess water and sodium in the body in order to decrease the workload of the heart.5

Surgery

There are also devices and surgical options to treat some causes of heart failure.2,7 They include implantable cardioverter defibrillator (ICD), cardiac resynchronization therapy (CRT), left ventricular assist device (LVAD), coronary artery bypass, valve replacement, and heart transplant.7

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. Managing HFrEF involves treating the cause of HF and related medical conditions.1 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.1 The first steps include limiting salt and fluid intake combined with medications and regular exercise.

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.9 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

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

Written by: Linda Minton | Last reviewed: November 2019
  1. Colucci W. Overview of the management of heart failure with reduced ejection fraction in adults. Up to Date. Available at: https://www.uptodate.com/contents/overview-of-the-management-of-heart-failure-with-reduced-ejection-fraction-in-adults?search=overview-of-the-therapy-of-heart-failure-with-reduced-ejection-fraction&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1. Accessed 10/7/19.
  2. Heart Failure Treatment. UCFS Health. Available at: UCFS Health. Available at: https://www.ucsfhealth.org/conditions/heart_failure/treatment.html. Accessed 10/7/19.
  3. Yancy CW, Jessup M, Bozkurt B, et al; American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. 2013 ACCF/AHA Guideline for the Management of Heart Failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;128:e240-327.
  4. ACCF and AHA Release Guidelines on the Management of Heart Failure. Am Fam Physician. 2014 Aug 1;90(3):186-189.
  5. Lifestyle changes for heart failure. American Heart Association. Available at: https://www.heart.org/en/health-topics/heart-failure/treatment-options-for-heart-failure/lifestyle-changes-for-heart-failure. Accessed 10/7/19.
  6. Devices and Surgical Procedures to Treat Heart Failure. American Heart Association. Available at: https://www.heart.org/en/health-topics/heart-failure/treatment-options-for-heart-failure/devices-and-surgical-procedures-to-treat-heart-failure. Accessed 10/7/19.
  7. HFpEF vs. HFrEF. Healio.com. Available at: https://www.healio.com/cardiology/hf-transplantation/news/online/%7Bb40f774c-5c15-4dcd-9ebe-3e0bd7f4f94e%7D/hfpef-vs-hfref. Accessed 10/7/19.
  8. Heart Failure Treatment & Management. Medscape. Available at: https://emedicine.medscape.com/article/163062-treatment#d13. Accessed 10/7/19.