Heart Failure

Care & Treatment

The first step in managing heart failure is to identify and treat its cause or causes.

Medications for Treating Heart Failure

Diuretics (water pills) and ACE inhibitors are the two most common medications for treating heart failure. 

Diuretics

These pills help eliminate excess fluid from the body and can increase urine production. They decrease fluid buildup and the amount of work the heart must do. Diuretics are usually prescribed as pills. However, in cases of acute heart failure, your healthcare provider may use an intravenous (IV) dose to get the medicine into your bloodstream faster. 

Angiotensin-Converting Enzyme (ACE) inhibitors

ACE inhibitors are especially useful for people with systolic heart failure. Treatment with ACE inhibitors can reduce symptoms and improve your quality of life. They also help you be more physically active, which is helpful for maintaining health and function. 

Diuretics and ACE inhibitors have potential side effects. These include very low blood pressure or changes in your blood’s chemical makeup. Your healthcare provider will regularly check your blood pressure and kidney function. 

In older adults, ACE inhibitors may sometimes cause a troubling cough or a loss of taste.  Be sure to let your healthcare provider know if you have these side effects. 

Other Medications for Heart Failure

Depending upon the type and degree of heart failure, your doctor may also prescribe: 

  • Angiotensin II receptor blockers, if you can’t tolerate the side effects of ACE inhibitors
  • Beta-blockers to slow the heart rate and block excess stimulation of the heart muscle
  • Nitroglycerin to dilate (widen) blood vessels and relieve chest pain
  • Aldosterone receptor blockers to block the action of the hormone aldosterone, which promotes salt and fluid retention.

The medication digoxin has long been used for heart failure, but recent studies have called into question whether it is more harmful than helpful. It should not be used as a first-line treatment for heart failure.  However, it may be appropriate for selected patients who are already taking other medications that are strongly recommended for heart failure.

Devices for Treating Heart Failure

Implantable Cardioverter-Defibrillators (ICDs)

Implantable cardioverter-defibrillators (ICDs) are battery-powered devices that are placed under the skin. They recognize when a person’s heart is beating abnormally. The battery then delivers an electric shock to return the heartbeat to a normal rhythm. ICDs can reduce the risk of sudden cardiac death in people with some forms of heart failure. In the United States, over 40% of these devices are implanted in patients 70 years or older.  However, there are disadvantages to using an ICD. Quality of life is lowered in people who receive one or more ICD shocks. Additionally, up to 20% of shocks are inappropriate. That means that shocks can occur even when an abnormal heartbeat is not life-threatening.

Left Ventricular Assist Devices (LVADs)

Left ventricular assist devices (LVADs) are implantable mechanical devices. They may reduce symptoms, increase exercise tolerance, and improve quality of life and survival in some patients with severe heart failure, including adults in their 70s and 80s. They are designed to ease symptoms and improve quality of life in patients who are not able to receive a heart transplant. However, older people are at increased risk of complications from LVADs, particularly bleeding in the stomach or intestines. Additionally, people who are frail or who have other advanced diseases in addition to heart failure may not be healthy enough to have LVADs implanted. 

 

Last Updated November 2017