Heart failure - Treatment (2024)

For most people, heart failure is a long-term condition that can't be cured. But treatment can help keep the symptoms under control, possibly for many years.

The main treatments are:

  • healthy lifestyle changes
  • medication
  • devices implanted in your chest to control your heart rhythm
  • surgery

In many cases, a combination of treatments will be required.

Treatment will usuallyneed to continue for the rest of your life.

Care plan

If you have heart failure, you and everyone involved in your care will be given a care plan.

This should include:

  • plans for managing your heart failure, including follow-up care, rehabilitation and access to social care
  • symptoms to look out for in case your condition worsens
  • details of how to contact your care team or specialist

The care plan should be reviewed at least every 6 months by your GP.

Lifestyle changes

Having a healthy lifestyle, including eating a balanced diet, doing exercise and not smoking, can help with your symptoms and reduce your risk of becoming seriously ill.

You should be offered an exercise-based cardiac rehabilitation programme.

Find out more about living with heart failure

Medicines for heart failure

Most people with heart failure are treated with medication. Often you'll need to take 2 or 3 different medicines.

Some of the main medicines for heart failure include:

  • ACE inhibitors
  • angiotensin-2 receptor blockers (ARBs or AIIRAs)
  • beta blockers
  • mineralocorticoid receptor antagonists
  • diuretics
  • ivabradine
  • sacubitril valsartan
  • hydralazine with nitrate
  • digoxin
  • SGLT2 inhibitors

You may need to try a few different medicines before you find a combination that controls your symptoms but doesn't cause unpleasant side effects.

ACE inhibitors

Angiotensin-converting enzyme (ACE) inhibitors work by relaxing and opening up your blood vessels, which makes it easier for your heart to pump blood around the body.

Examples of ACE inhibitors include ramipril, captopril, enalapril, lisinopril and perindopril.

The most common side effect of ACE inhibitors is a dry, irritating cough.

If you have a troublesome cough, an ACE inhibitor may be switched to an ARB.

ACE inhibitors can also cause your blood pressure to fall too low, and they may cause kidney problems. Your GP will monitor this.

Angiotensin-2 receptor blockers (ARBs)

Angiotensin-2 receptor blockers (ARBs) work in a similar way to ACE inhibitors by relaxing blood vessels and reducing blood pressure.

They tend to be used as an alternative to ACE inhibitors because they don't usually cause a cough, although they may not be quite as effective as ACE inhibitors.

Examples of ARBs include candesartan, losartan, telmisartan and valsartan.

Side effects of ARBs can include low blood pressure and high levels of potassium in your blood.

Your doctor will carry out regular blood tests to monitor your potassium level.

Important: Coronavirus advice

If you have coronavirus (COVID-19), or think you might have it, keep taking your blood pressure medicines as usual.

There is no clear evidence that taking angiotensin-converting enzyme (ACE) inhibitors or angiotensin-2 receptor blockers (ARBs) will cause complications.

Beta blockers

Beta blockers work by slowing your heart down and protecting your heart from the effects of adrenaline and noradrenaline, "fight or flight" chemicals produced by the body.

There are several different beta blockers, but the main ones used to treat heart failure in the UK are bisoprolol, carvedilol and nebivolol.

Possible side effects include dizziness, tiredness and blurred vision.

But most people taking them have either no or very mild side effects that become less troublesome with time.

Mineralocorticoid receptor antagonists (MRAs)

MRAs make you pass more urine, and help lower blood pressure and reduce fluid around the heart, but they don't reduce potassium levels.

The most widely used MRAs are spironolactone and eplerenone.

Spironolactone may cause enlarged breasts in men (gynaecomastia) and breast tenderness and increased hair growth in women.

Eplerenone can cause sleeping difficulties, dizziness and headaches.

The most serious side effect of these medicines is that they can cause the level of potassium in your blood to become dangerously high.

Your doctor will carry out regular blood tests to check for this.

Diuretics

Diuretics (water pills) make you pass more urine and help relieve ankle swelling and breathlessness caused by heart failure.

There are many different types of diuretic, but the most widely used for heart failure are furosemide (also called frusemide) and bumetanide.

Possible side effects of diuretics include dehydration and reduced levels of sodium and potassium in the blood.

Ivabradine

Ivabradine is a medicine that can help slow your heart down.

It's a useful alternative to beta blockers if you can't take them or they cause troublesome side effects.

It can also be used alongside beta blockers if they don't slow the heart enough.

Possible side effects include headaches, dizziness and blurred vision.

Sacubitril valsartan

Sacubitril valsartan is a single tablet that combines an ARB and a medication called a neprilysin inhibitor.

It's suitable for people with more severe heart failure, whose heart is only able to pump a reduced amount of oxygenated blood around the body despite taking other medication.

The most common side effects of sacubitril valsartan are low blood pressure, high potassium levels and kidney problems.

Hydralazine with nitrate

Hydralazine in combination with nitrate can help relax and open up the blood vessels.

These medicines are sometimes prescribed by heart specialists (cardiologists) for people who are unable to take an ACE inhibitor or ARB.

Side effects can include headaches, a fast heartbeat and a pounding, fluttering or irregular heartbeat (palpitations).

Digoxin

Digoxin can improve your symptoms by strengthening your heart muscle contractions and slowing down your heart rate.

It's normally only recommended for people who have symptoms despite treatment with ACE inhibitors, ARBs, beta blockers and diuretics.

Possible side effects include dizziness, blurred vision, feeling and being sick, diarrhoea and an irregular heartbeat.

SGLT2 inhibitors

SGLT2 inhibitors are tablets that can help lower your blood sugar levels.

Empagliflozin and dapagliflozin are types of SGLT2 inhibitor. They can be used to treat some types of heart failure, as an add-on to other medicines.

Possible side effects include thrush, peeing more than usual, a mild skin rash and back pain.

Take your medication

It's very important that you take any prescribed medication, even if you begin to feel better.

Check with your care team if:

  • other medicines might interfere with your medication
  • you experience any side effects

Devices for heart failure

Some people with heart failure will need to have a procedure to implant a small device in their chest that can help control or monitor their heart's rhythm.

The most commonly used devices are:

  • pacemakers
  • cardiac resynchronisation therapy (CRT)devices
  • implantable cardioverter defibrillators (ICDs)
  • CRT-Ds

Pacemakers

You may need to have a pacemaker fitted if your heart beats too slowly.

A pacemaker monitors your heart rate continuously, andsends electrical pulses to your heart to keep it beating regularly and at the right speed.

The pacemaker is implanted under the skin by a cardiologist, usually under local anaesthetic.

You'll usually need to stay in hospital overnight to check it's working properly. Serious complications are unusual.

Pacemakers need to be checked regularly by specialist technicians at a pacemaker clinic.

You'll also need to be careful about things that can affect how your pacemaker works, such as hospital equipment and security systems in shops or at airports.

Read more about pacemaker implantation.

You can also find out more aboutpacemakers on the British Heart Foundation website.

Cardiacresynchronisation therapy

In some people with heart failure, the walls ofthe main pumping chamber(the left ventricle) don'twork together and contract out of sync with each other.

Cardiac resynchronisation therapy (CRT)is a special type of pacemaker that can correct the problem by making the walls of the left ventricle all contract at the same time. This makes the heart pumpmore efficiently.

Most pacemakers only have 1 or 2 wires to the heart, but CRT requires an extra wire.

Implantablecardioverter defibrillators (ICDs)

People who have, or are at high risk of developing, an abnormal heart rhythm may need to have a device known asan implantable cardioverter defibrillator (ICD) fitted.

An ICD constantly monitors the heart rhythm.

If the heart starts beating dangerously fast, the ICDwill try to bring it back to normal by giving it a small, controlled electrical shock (defibrillation).

If this fails, the ICD will deliver a larger shock.

As with pacemakers, ICDs are implanted in hospital, usually under local anaesthetic.

Like pacemakers, you'll need to avoid things that can interfere with the way the ICD works, such as airport security systems.

Read more aboutICDs on the British Heart Foundation website.

CRT-Ds

Devicesthat combine cardiac resynchronisation anddefibrillation are implanted into patients who need both.

These combinationdevices are usually called CRT-Ds.

Pulmonary artery pressure sensors

Some people with chronic heart failure may need to have a device known as a pulmonary artery pressure sensor fitted.

It's implanted into your artery in hospital, under local anaesthetic.

The sensor sends blood pressure measurements to a monitor in your home. The monitor sends the measurements to your care team, to help them decide whether your treatment needs to be changed. This should help to manage your treatment and reduce the chance of you being admitted to hospital.

This is a new procedure that might not yet be available to everyone.

Improving muscle strength

If you are having a bad flare-up and are unable to exercise, you may be offered electrical stimulation to make your muscles stronger.

This is where electrodes are placed on your skin and small electrical impulses are sent to weak muscles, usually in your arms or legs.

Surgery

Medicines are the main treatment for heart failure, but for some peoplesurgery may help.

Operations that can help with heart failure include:

  • heart valve surgery
  • a coronary angioplasty or bypass
  • left ventricular assist devices
  • heart transplant

Heartvalve surgery

If the valves of your heart are damaged or diseased, your doctor may suggest valve surgery.

There are 2 types of valve surgery: valve replacement and valve repair.

The type of surgery you have will depend on what's wrong with the valve and how serious the problem is.

Your doctor will discussthis with you.

Read aboutaortic valve replacement and surgery for mitral valve problems.

Angioplastyor bypass

If your heart failure is related to coronary heart disease, your doctor may recommend a:

  • coronary angioplasty–where a tiny balloon is used to stretch open a narrowed or blocked artery; usually a small mesh tube called a stent is put in the artery to support it
  • coronary artery bypass graft (CABG)–where a blood vessel from another part of the body is used to divert blood around narrowed or clogged parts of an artery

These procedureswill help make it easier for your heart to pump blood around your body.

Leftventricular assist devices

Left ventricular assist devices (LVADs) are mechanical pumps that can help if yourleft ventricle isn't working properly and medication alone isn't helping.

Theymay be used as a permanent treatment if you can't have a heart transplant, or as a temporary measure while you wait for a transplant.

In addition to the pump, LVADs also include an external battery. A wire connecting this to the pump will need to be placed under your skin during the operation.

Read more aboutLVADs on the British Heart Foundation website.

Hearttransplant

A heart transplant may be necessary if you developsevere heart failure that can't be treated effectively with medication or other types of surgery.

A heart transplant is a complex procedure that carries serious risks, so it's not suitable for everyone with severe heart failure.

There's also a shortage of hearts for transplantation, so some people have to wait years for a suitable donor heart to become available.

Page last reviewed: 19 May 2022
Next review due: 19 May 2025

Heart failure - Treatment (2024)

FAQs

Can a person recover from heart failure? ›

There are medicines and treatments that reverse many cases of heart failure, and in most cases, the outlook is generally very good.

How long can you survive with heart failure? ›

Another study showed that the survival rates of people with chronic heart failure were: 80% to 90% for one year. 50% to 60% for year five. 30% for 10 years.

Can you stop heart failure from progressing? ›

Heart failure has no cure. But treatment can help you live a longer, more active life with fewer symptoms. Treatment depends on the type of heart failure you have and how serious it is.

How is heart failure managed? ›

Treatment often includes lifestyle changes and medicines. If another health condition is causing the heart to fail, treating it may reverse heart failure. Some people with heart failure need surgery to open blocked arteries or to place a device to help the heart work better.

What does stage 1 heart failure feel like? ›

If you've been diagnosed with stage one of congestive heart failure, it is because a doctor has noticed a weakness in your heart. This news may be surprising, as stage one of CHF does not exhibit any symptoms.

Which are two signs of worsening heart failure? ›

Symptoms that may indicate that heart failure is getting worse may include:
  • increased shortness of breath.
  • swelling in the ankles, legs, abdomen, or other parts of your body.
  • fatigue.
  • chest discomfort.
  • sudden weight gain.
  • reduced exercise tolerance.
  • persistent cough or wheezing.
  • increased heart rate.
Aug 11, 2023

Is heart failure always terminal? ›

Outlook for heart failure

It can severely limit the activities you're able to do and is often eventually fatal. But it's very difficult to tell how the condition will progress on an individual basis. It's very unpredictable. Lots of people remain stable for many years, while in some cases it may get worse quickly.

How do you know the end is near with congestive heart failure? ›

These are the common symptoms of end-stage heart failure: pain. breathlessness on minimal exertion or at rest. persistent cough.

Can you come out of heart failure? ›

Heart failure is a long-term condition, but people with can live long and full lives with it. Although there's no cure for heart failure, you can stop your condition getting worse by taking your medicines, certain treatments and changes to your lifestyle.

What is the best thing to do if you have heart failure? ›

Looking after yourself
  • Have a healthy diet. A healthy, balanced diet can help improve your symptoms and general health. ...
  • Exercise regularly. Regular physical activity can also help improve your symptoms and general health. ...
  • Stop smoking. ...
  • Limit your alcohol consumption. ...
  • Get vaccinated.

Can heart failure go into remission? ›

As each AHF event is associated with more events and mortality, preventing initial events will likely also improve long‐term survival. Hence, those who improve on treatment can be thought of being in HF in remission.

Can a weak heart become strong again? ›

How can someone strengthen their heart muscle? “A good diet, exercise and controlling your blood pressure and cholesterol all help promote a strong heart and prevent heart disease. For people who already have a weak heart, low sodium intake, proper exercise and compliance with medications can all prevent more problems.

What is the miracle drug for heart failure? ›

The study found that empagliflozin reduced the risk of hospitalization or death from heart failure by 21 percent compared to placebo, driven by a 29 percent decline in hospitalization.

What is the number one drug for heart failure? ›

What is the first drug of choice for heart failure? Healthcare providers often prescribe ACE inhibitors and beta blockers as first-line treatments. These drugs are especially helpful for people who have a reduced ejection fraction.

Do you sleep a lot with heart failure? ›

Can heart problems make you sleep a lot? As your heart works overtime, it can cause tiredness, shortness of breath and feeling worn out. These symptoms are all signs of fatigue, one of the most common symptoms of congestive heart failure.

Can the heart repair itself after heart failure? ›

The heart is unable to regenerate heart muscle after a heart attack and lost cardiac muscle is replaced by scar tissue. Scar tissue does not contribute to cardiac contractile force and the remaining viable cardiac muscle is thus subject to a greater hemodynamic burden.

Can heart failure be completely reversed? ›

Congestive heart failure (CHF) is a condition in which your heart is no longer able to pump enough blood to consistently meet your body's needs. It's usually a chronic condition that worsens over time. But if it's diagnosed and treated early on, CHF can sometimes be reversed or at least halted for a time.

Can someone be saved from heart failure? ›

Although there's no cure for heart failure, you can stop your condition getting worse by taking your medicines, certain treatments and changes to your lifestyle.

How quickly does heart failure progress? ›

Outlook for heart failure

It can severely limit the activities you're able to do and is often eventually fatal. But it's very difficult to tell how the condition will progress on an individual basis. It's very unpredictable. Lots of people remain stable for many years, while in some cases it may get worse quickly.

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