Treatment of Heart Failure
The treatment of heart failure is multifaceted and must be tailored to the individual’s symptoms, type of heart failure, underlying cause, and stage of progression. Effective treatment of heart failure aims to alleviate symptoms, slow or reverse disease progression, reduce hospitalisations, and improve overall survival and quality of life. Management strategies typically include lifestyle modifications, pharmacological therapy, device implantation, surgical interventions, and long-term monitoring.
The cornerstone of treatment is lifestyle modification, which helps reduce the workload on the heart and prevent symptom exacerbation. Patients are advised to:
Limit sodium intake, typically to less than 2 grams per day, to minimise fluid retention.
Monitor daily weight, with sudden gains signalling fluid accumulation and early decompensation.
Restrict fluid intake, especially in moderate to severe heart failure, usually to 1.5–2 litres per day.
Quit smoking and avoid alcohol, both of which can exacerbate symptoms and increase mortality.
Engage in supervised physical activity, such as cardiac rehabilitation, to improve cardiovascular fitness and mental well-being.
Nutritional counselling and patient education are critical for empowering individuals to manage their condition effectively at home. Understanding symptom patterns and adhering to treatment regimens can dramatically reduce hospital admissions and improve independence.
Pharmacological treatment forms the foundation of most management plans. The specific medications prescribed depend on whether the patient has heart failure with reduced ejection fraction (HFrEF) or preserved ejection fraction (HFpEF).
Treatment of Heart Failure
For patients with HFrEF, evidence-based medications include:
ACE inhibitors or ARBs (angiotensin receptor blockers): Reduce afterload and improve survival.
Beta-blockers: Slow the heart rate, reduce oxygen demand, and improve heart function.
Mineralocorticoid receptor antagonists (e.g., spironolactone): Decrease fluid retention and fibrosis.
SGLT2 inhibitors (e.g., dapagliflozin, empagliflozin): Originally used for diabetes, now shown to improve heart failure outcomes in both diabetic and non-diabetic patients.
ARNI (angiotensin receptor-neprilysin inhibitor), such as sacubitril/valsartan: Offers superior outcomes compared to ACE inhibitors in many cases.
Diuretics, especially loop diuretics (e.g., furosemide), are used to relieve symptoms of fluid overload, such as breathlessness and oedema, though they do not alter long-term survival.
In HFpEF, fewer treatments have shown mortality benefit, but symptom control is still vital. Diuretics remain the primary therapy for fluid retention. Managing comorbidities like hypertension, diabetes, and atrial fibrillation is key. Emerging research is exploring the role of SGLT2 inhibitors and other agents in this subgroup.
Device therapy is indicated for selected patients, particularly those with electrical conduction abnormalities or high risk of sudden cardiac death:
Implantable cardioverter-defibrillators (ICDs): Used in patients with significantly reduced ejection fraction (typically <35%) to prevent fatal arrhythmias.
Cardiac resynchronisation therapy (CRT): Recommended for patients with wide QRS complexes and heart failure symptoms, CRT uses biventricular pacing to improve cardiac efficiency.
Left ventricular assist devices (LVADs): Employed in advanced heart failure as a bridge to transplantation or as destination therapy in those ineligible for transplant.
For patients with valvular disease, surgical or transcatheter interventions may be necessary. Repair or replacement of faulty valves can relieve pressure on the heart and improve function. Similarly, individuals with obstructive coronary artery disease may benefit from coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) to restore adequate blood supply.
Treatment of Heart Failure
In end-stage heart failure, where symptoms persist despite optimal medical therapy, heart transplantation may be considered. While limited by donor availability and eligibility criteria, transplant remains a life-saving option for carefully selected patients and offers excellent long-term outcomes.
A key component of treatment is ongoing monitoring. Regular follow-ups with a cardiologist help assess disease progression, adjust medications, and detect complications early. Remote monitoring tools—including blood pressure cuffs, weight logs, and smartphone-based applications—allow patients to report symptoms and data from home, reducing the risk of hospitalisation.
Cardiac rehabilitation is highly recommended after diagnosis or following decompensated episodes. These programmes combine exercise, education, counselling, and lifestyle guidance in a structured setting. They help improve physical function, reduce anxiety and depression, and enhance adherence to treatment plans.
Psychosocial support is equally important. Many patients experience depression, anxiety, or frustration due to symptom burden and limitations in daily life. Involving mental health professionals, social workers, or peer support groups can dramatically improve emotional resilience and quality of life.
Treatment of Heart Failure
Patient and family education is vital to success. Individuals should be taught to recognise warning signs of decompensation—such as sudden weight gain, increased breathlessness, or swelling—and know when to seek medical attention. Family members or caregivers should be involved in learning how to support medication schedules, dietary plans, and emergency responses.
The treatment of heart failure is constantly evolving. Recent innovations include novel medications, wearable monitors, gene therapy research, and artificial intelligence tools that predict decompensation. As the understanding of heart failure deepens, more personalised and precise treatments are becoming available, improving prognosis and quality of life.
In summary, the treatment of heart failure requires a multidisciplinary approach that blends medical management with lifestyle change, technology, education, and emotional support. When coordinated effectively, these strategies enable patients to live longer, healthier, and more fulfilling lives.
