How Is Heart Failure Treated?

Early diagnosis and treatment can help people with heart failure live longer, more active lives. How heart failure is treated will depend on your type and stage of heart failure (how severe it is).

The goals of treatment for all stages of heart failure are to:

• Treat the underlying cause of your heart failure, such as coronary artery disease (CAD), high blood pressure, or diabetes
• Reduce your symptoms
• Stop your heart failure from getting worse
• Increase your lifespan and improve your quality of life

For people with any stage of heart failure, treatment will include lifestyle measures, medicines, and ongoing care. People who have more severe heart failure also may need medical procedures and surgery.

Lifestyle Measures

You can take simple steps to help yourself feel better and control heart failure. The sooner you start these measures, the better off you're likely to be.

Follow a Healthy Eating Plan

A diet low in salt, fat, saturated fat, trans fat, and cholesterol can help you prevent or control heart failure. Salt can cause extra fluid to build up in your body, making heart failure worse. Fat and saturated fat can increase your blood cholesterol levels. Trans fat raises your LDL ("bad") cholesterol and lowers your HDL ("good") cholesterol. High blood cholesterol can cause heart disease, which in turn can cause heart failure.

A balanced diet with varied nutrients can help your heart work better. Getting enough potassium is key for people with heart failure. Some heart failure medicines deplete the potassium in your body. This can put people with heart failure in danger. Lack of potassium can cause very rapid heart rhythms that lead to sudden death.

Potassium is found in foods like bananas, strawberries, raisins, beets, and greens. Talk to your health care team about getting the correct amount of potassium.

If you have heart failure, you shouldn't drink alcohol. If you have severe heart failure, your doctor may advise you to limit the amount of fluids that you drink.

Examples of healthy eating plans are the National Heart, Lung, and Blood Institute's Therapeutic Lifestyle Changes (TLC) diet and the Dietary Approaches to Stop Hypertension (DASH) eating plan.

The TLC diet is low in saturated fat and cholesterol to help lower blood cholesterol. The DASH eating plan contains less salt/sodium, sweets, added sugars, fats, and red meat than the typical American diet. Fruits, vegetables, fat-free or low-fat diary products, whole grains, fish, poultry, beans, seeds, and nuts are the focus of the plan.

Adopt Healthy Habits

Taking steps to control risk factors for CAD, high blood pressure, and diabetes also will help control heart failure.

• Lose weight if you're overweight or obese. Work with your health care team to lose weight safely.
• Do physical activity as your doctor directs to become more fit and stay as active as possible.
• Quit smoking and avoid using illegal drugs. Avoid exposure to secondhand smoke. Smoking and drugs can worsen heart failure and harm your health.
• Get enough rest.

Medicines

Your doctor will base your medicine treatment on the type of heart failure you have, how severe it is, and your response to certain medicines. The following are the main medicines for treating heart failure.

• Diuretics (water or fluid pills) help reduce fluid buildup in your lungs and swelling in your feet and ankles.
• ACE inhibitors lower blood pressure and reduce strain on your heart. They also may reduce the risk of a future heart attack.
• Aldosterone antagonists trigger the body to get rid of salt and water through urine, which lowers the volume of blood that the heart must pump.
• Angiotensin receptor blockers relax your blood vessels and lower blood pressure, so the heart doesn't have to work as hard.
• Beta blockers slow your heart rate and lower your blood pressure to decrease the workload on your heart.
• Isosorbide dinitrate/hydralazine hydrochloride helps relax your blood vessels, so your heart doesn't work as hard to pump blood. The Food and Drug Administration approved this medicine for use in African Americans after studies showed it worked well for this group.
• Digoxin makes the heart beat stronger and pump more blood.

Many people with severe heart failure must be treated in the hospital from time to time. In the hospital, you may receive new or special medicines, but you will keep taking your other medicines too. Some people with very severe heart failure are given intravenous (IV) medicines, which are injected into veins in their arms.

Your doctor also will order extra oxygen if you take medicine but still have trouble breathing. The extra oxygen can be given in the hospital and at home.

Ongoing Care

It's important to watch for signs that heart failure is getting worse. Weigh yourself each day. Let your doctor know right away if you have a sudden weight gain or weight loss. Either one can signal a need to adjust your treatment. If your doctor advises you to limit your intake of fluids, carefully watch how much you drink during the day.

It's also important to get medical care for other related conditions. If you have diabetes and/or high blood pressure, work with your health care team to control your condition(s). Have your blood sugar level and blood pressure checked. Your doctor will tell you how often to come in for tests and how often to take measurements at home.

Medical Procedures and Surgery

As heart failure worsens, lifestyle changes and medicines may no longer control heart failure symptoms. You may need a medical procedure or surgery.

If you have heart damage and severe heart failure symptoms, you may need:

• Cardiac resynchronization therapy. In heart failure, the right and left sides of the heart may no longer contract at the same time. This disrupts the heart's pumping. To correct this problem, doctors may implant a type of pacemaker near your heart. This device helps both sides of the heart contract at the same time, which may decrease heart failure symptoms.
• An implantable cardioverter defibrillator (ICD). Some people with heart failure have very rapid, irregular heartbeats. Without treatment, the problem can cause sudden cardiac arrest. Doctors implant ICDs to solve this problem. ICDs are similar to pacemakers. The device checks your heart rate and corrects heart rhythms that are too fast.

People who have heart failure symptoms at rest despite other treatments may need:

• A mechanical heart pump, such as a left ventricular assist device. This device helps pump blood from the heart to the rest of the body. People may use pumps until they have surgery or as a long-term treatment.
• Heart transplant. When all other treatments fail to control symptoms, some people who have heart failure receive healthy hearts from deceased donors.
• Experimental treatments. Studies are under way to see whether open-heart surgery or angioplasty (a procedure used to unblock heart arteries and improve blood flow) can reduce heart failure symptoms.

Ongoing Research

Researchers continue to learn more about heart failure and how to treat it. As a result, treatments are getting better.

People with heart failure often can be treated in a research study. You get top care from heart failure experts and the chance to help advance heart failure knowledge and care.

You also may want to take part in a heart failure registry, which tracks the course of disease and treatment in large numbers of people. These data help research move forward. You may help yourself and others by taking part. Talk to your health care team to learn more.