Heart Failure

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Care & Treatment

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

For example, diabetes, high blood pressure and other conditions that contribute to heart failure need treatment. And, those with heart failure need to quit smoking and limit alcohol intake.

Lifestyle Changes and Rehabilitation

Salt Levels

Guidelines for people with heart failure are to limit salt to less than 3 grams a day, except for people with severe heart failure who may require less salt. Some people with heart failure may not be able to maintain their nutritional needs if they eat low salt foods. In such situations, using other seasonings to add extra flavor to the food while allowing slightly extra salt might be ok.

Fluid Intake

Fluid restriction is usually only needed for people with severe heart failure. People with the disease should avoid excess fluids and limit fluids to 2 liters a day. It is important to remember that intake of tea, coffee, juices, soups, and fruits with high water content (as water melon) need to be added into the calculation of daily fluid consumption.

Exercise

Regular physical activity improves the health of people with heart failure. Activity time and difficulty needs to be individually tailored to the person’s physical health.

Cardiac Rehabilitation

Cardiac rehabilitation for people with stable symptoms and an LVEF of 35 percent or less is effective for older adults with heart failure. Medicare generally covers this service.

Disease Management Program

Older adults with moderate or severe heart failure can benefit from a heart failure disease management program. This program takes a comprehensive approach to helping a person with heart failure manage their condition.

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 the body get rid of extra fluid. So the person taking them will urinate more. The drug decreases fluid buildup and the amount of work the heart must do. Diuretics are usually pills. When a person is in hospital for sudden buildup of fluid in the body due to heart failure, the healthcare provider may use an intravenous (IV) dose to get the medicine into the bloodstream faster. 

Angiotensin-Converting Enzyme (ACE) inhibitors

ACE inhibitors can reduce symptoms of heart failure and improve quality of life.

Side effects of diuretics and ACE inhibitors include:

  • Very low blood pressure
  • Changes in the electrolyte levels in blood as increasing levels of potassium in blood
  • A dry cough or a loss of taste among older adults

A healthcare provider needs to regularly check your blood pressure, electrolytes, and kidney function.  

Other Medications for Heart Failure

Depending upon the type and degree of heart failure, a healthcare professional may also prescribe: 

  • Angiotensin II receptor blockers, if a person can’t handle 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 causes salt and fluid retention.

Digoxin has been used in the past for heart failure. However, it may be more harmful than helpful. Some people who are already taking other medications or who have side effects from other heart failure medications may need to take digoxin.

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 lower the risk of sudden cardiac death in people with some types of heart failure. Some problems with ICDs are:

  • Quality of life is lowered in people who receive one or more ICD shocks
  • Up to 10 percent of shocks are necessary. This means that shocks can occur even when an abnormal heartbeat is not life-threatening. 

Cardiac Resynchronization Therapy (CRT)

Cardiac resynchronization therapy (CRT) is for people with advanced HFrEF and persistent severe heart failure symptoms. CRT involves a implanting a pacemaker in a person’s body. It stimulates both heart ventricles (the two lower chambers of the heart). CRT can improve:

  • Heart failure symptoms
  • Ability to exercise
  • Quality of life
  • Survival

Left Ventricular Assist Devices (LVADs)

Left ventricular assist devices (LVADs) are another type of mechanical device. They can:

  • Reduce heart failure symptoms
  • Increase ability to exercise
  • Improve quality of life and survival in some patients with severe heart failure, including adults in their 70s and 80s.

LVADs are for people who aren’t able to get a heart transplant. Older people have a higher risk of complications from LVADs, particularly bleeding in the stomach or intestines. Some people may not be healthy enough to get LVADs. 

 

Last Updated February 2023

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