Treatment for Heart Failure: A GoodRx Guide to Medications and More
Key takeaways:
In heart failure, the heart doesn’t pump as effectively as normal. The type of heart failure you have plays an important role in treatment decisions.
The main treatment for heart failure is usually a combination of medications and specific healthy lifestyle changes.
More advanced cases of heart failure may need specialized devices or surgery for treatment.
Table of contents
Anyone living with heart failure knows that it can have a big effect on different aspects of life. For many, it means managing the condition and its symptoms on a daily basis.
Fortunately, there are a lot of options for treating heart failure. And it goes beyond the wide range of medications that can help. It also includes changes to diet and exercise. There are even some devices and procedures that can help. We’ll discuss all the options that can help your heart run smoothly to keep you feeling your best.
What is congestive heart failure?
Heart failure means that the heart is not able to pump blood well enough to meet the body’s needs. And when the heart can’t pump effectively, it can lead to fluid buildup in different parts of the body. This can lead to symptoms like shortness of breath or swelling in the legs and belly.
There are two main categories of heart failure: right-sided and left-sided heart failure. And it’s helpful to know what kind you have because this plays an important role in the treatment that’s best for you.
Left-sided heart failure
The left side of the heart is the stronger side, and it pumps blood to most parts of the body. Left-sided heart failure can be caused by things, like coronary artery disease, long-standing high blood pressure, or heart valve problems.
There are two types of left-sided heart failure:
Heart failure with reduced ejection fraction (EF): EF measures how much blood the heart squeezes out with each beat. Normally, the EF is at least 50%. But up to 70% is normal. This means the heart is pumping out more than half the blood inside of it with each beat. But when the heart muscle becomes weak, it can’t squeeze as effectively and the EF may lower.
Heart failure with preserved EF: In this type of heart failure, the EF is normal. But the heart muscle is too stiff. This affects the heart’s ability to fill up with blood between each heartbeat. This means it has less blood to pump forward with each beat.
Right-sided heart failure
The right side of the heart pumps blood to the lungs so it can get oxygenated. It’s less common, but the right side of the heart can have heart failure as well.
Several conditions can cause right-sided heart failure. One common cause is lung disease, like COPD (chronic obstructive pulmonary disease) or emphysema. But, over time, left-sided heart failure can also lead to right heart failure. So some people can have both types of heart failure together.
The main medications for heart failure treatment
Several different types of medications are used to treat heart failure. You may not need all of these medications. But often the different types of medications work better when they’re used together.
There are evidence-based guidelines to help you and your provider figure out the best medication(s) for you. This will depend on:
Your heart failure symptoms
Your heart function
The type of heart failure you have
The cause of your heart failure
Your other medical conditions
Diuretics are medications that stimulate the kidneys to make more urine. This helps the body get rid of extra fluid that can build up from heart failure.
Common examples of diuretics are:
Furosemide (Lasix)
Bumetanide (Bumex)
Torsemide (Demadex)
Metolazone (Zaroxolyn)
Hydrochlorothiazide (Microzide)
Chlorthalidone (Thalitone)
Diuretics make you pee a lot, and this side effect can be bothersome. Diuretics can also lead to:
Dehydration
Low blood pressure
Lightheadedness
Dry mouth
Low levels of potassium and magnesium
Many people with heart failure take diuretics every day for the long term. Sometimes, you may need to take extra doses when you have more symptoms or your daily water weight is higher. Other times, you can lower the amount of diuretics you need by being careful about how much fluid you drink and how much salt you consume.
If you take a diuretic, your provider will likely schedule an occasional blood test to check your potassium and magnesium levels.
Aldosterone is a chemical in the body that tells the kidneys to hold onto salt and fluid. It also has a direct effect on the heart, and it can cause the heart to work harder. Both of these effects can be a problem for people with heart failure.
Aldosterone receptor blockers are medications that block the effects of aldosterone. Examples include:
These medications work like mild diuretics. They also can help prevent stiffening of the heart muscle. They’re particularly useful for people with a reduced ejection fraction.
Side effects of aldosterone inhibitors include:
Stomach upset
Breast tenderness
More growth of body hair
Fatigue
Diarrhea
Abnormal kidney function
Because they can raise potassium levels, aldosterone inhibitors are not safe for everyone. For example, people with kidney disease are at higher risk of developing high potassium. They can also interact with other medications that affect the kidneys and potassium levels. If you’re taking an aldosterone receptor blocker, your provider will check your potassium level with a blood test.
Beta blockers are an important part of heart failure treatment. They help lower how much the heart works by:
Lowering blood pressure
Slowing down the heart rate
Reducing how hard the heart squeezes
For people with a low ejection fraction, beta blockers lower the risk of dying from heart-related conditions. For people with a normal ejection fraction, beta blockers may still be a good choice, especially if they have high blood pressure.
The best beta blockers for heart failure are:
Metoprolol (Toprol)
Carvedilol (Coreg)
Although there are other beta blockers available, these three are approved to treat heart failure.
In certain cases, beta blockers can worsen heart failure. This is why people often start at a low dose. Other side effects of beta blockers are:
Low blood pressure
Dizziness
Fatigue
Angiotensin converting enzyme inhibitors (ACE inhibitors) and angiotensin II receptor blockers (ARBs) are related medications. They work on angiotensin II, a chemical in the body that increases blood pressure. ACE inhibitors and ARBs lower the effect of angiotensin II. In turn, they reduce blood pressure.
These medications also have protective effects for the heart itself. So even if you have normal blood pressure, you may still benefit from an ACE inhibitor or ARB. Ideally, most people with heart failure with a reduced ejection fraction should take an ACE inhibitor or an ARB. Even in small doses, these medications can help you live longer.
But you might not be able to take ACE inhibitors or ARBs if:
Your blood pressure is too low.
You have serious reactions to them.
You have certain kidney problems.
Common examples of ACE inhibitors are:
Lisinopril (Zestril)
Benazepril (Lotensin)
Captopril (Capoten)
Ramipril (Altace)
Quinapril (Accupril)
Common ARBs are:
Losartan (Cozaar)
Valsartan (Diovan)
Candesartan (Atacand)
Azilsartan (Edarbi)
Olmesartan (Benicar)
Irbesartan (Avapro)
There’s also a combination ARB medication called sacubitril / valsartan (Entresto). For people with reduced ejection fraction, this medication helps symptoms and prolongs lifespan. If you take Entresto, it’s important that you avoid taking any other ACE inhibitors or ARBs because this can cause dangerous side effects.
ACE inhibitors can cause a dry cough. This is not usually the case for ARBs. Other side effects of ACE inhibitors and ARBs are:
Dehydration
Low blood pressure
Lightheadedness
Dizziness
Kidney problems
High potassium
In rare cases, these medications can cause swelling of the face, tongue, and throat. This is angioedema, and it requires immediate medical attention.
Other medications used in heart failure treatment
The medication categories above are the most common medications used for heart failure treatment. But there are several other types of medications that can be used in heart failure.
Vasodilators lower blood pressure by increasing the size of blood vessels. This makes it easier for the heart to pump blood forward.
The two vasodilators used to treat heart failure are:
Hydralazine (Apresoline)
Isosorbide dinitrate (Imdur)
These two medications are usually used together. There’s also a combination pill — BiDil.
Vasodilators may be helpful if you can’t take an ACE inhibitor or ARB. That’s because vasodilators don't affect the kidneys or raise potassium levels. The combination treatment is especially helpful for treating heart failure in Black Americans with reduced ejection fraction. That’s because it has been shown to increase lifespan in this group. For other groups of people, the results have been mixed.
Side effects of vasodilators are:
Headaches
Dizziness
Nausea
Vomiting
Diarrhea
Empagliflozin (Jardiance), dapagliflozin (Farxiga), and sotagliflozin (Inpefa) belong to a class of drugs known as SGLT-2 inhibitors. These three drugs were originally developed to treat diabetes. But research has shown that they have many benefits for people with heart failure, even if they don’t have diabetes.
These medications can reduce someone’s risk of hospitalization and death from heart failure. They are protective for people with both normal and low ejection fractions. An SGLT-2 inhibitor is usually added to other medications for heart failure.
Side effects of SGLT-2 inhibitors include:
Urinary tract infections (UTIs)
Yeast infections
Dehydration
Low blood sugar
Dizziness
These three medications work well whether or not you have Type 2 diabetes. But people with Type 1 diabetes should not use them
Digoxin is a little different from other heart failure medications. Rather than decreasing the work that the heart does, it increases the strength of the heart’s contractions.
If your ejection fraction is low, digoxin might be a treatment option to add to your other medications for heart failure. That’s because research suggests that it can help prevent hospitalization. But digoxin is not used as much as it was in the past. That’s because the other medications for heart failure are often safer and more effective.
Side effects of digoxin are:
Poor appetite
Nausea
Vomiting
Vision changes
Confusion
Abnormal heart rhythms
If you’re taking digoxin, you will need to check your digoxin blood levels from time to time. That’s because high levels can be toxic to the heart and body.
Ivabradine is a medication that slows down the heart rate. It’s best for people with an ejection fraction lower than 35% and a heart rate above 70 beats per minute (even with high doses of beta blockers). In this group, it can help lower the risk for hospitalization or death.
Ivabradine can cause some side effects, including:
Slow heart rate
Fatigue
Irregular heartbeat
Dizziness
Blurred vision
Omega-3 fatty acids are found in fish oil and over-the-counter fish oil capsules or prescription medication, such as:
There’s evidence that omega-3 pills can help reduce hospitalizations for heart failure.
Side effects of omega-3 fatty acids include:
Burping and indigestion
A bad taste in the mouth
Diarrhea
High doses of omega-3 fatty acids may also raise your risk for atrial fibrillation. So it's best to check with your provider before starting a supplement.
Lifestyle changes for heart failure treatment
If you have heart failure, treatment is not all about medication. Some lifestyle changes can go a long way toward protecting your heart.
Choosing a healthy diet
For anyone with heart failure, there are two important dietary recommendations:
Keep salty foods to a minimum. For many people, this means a target of less than 1,500 mg of sodium per day. Cutting back on salt can be challenging. But it can keep you from holding onto fluid. This may help you to lower how much medication you need.
Watch your fluids. Some people with heart failure need to limit the fluids they drink. Your provider can tell you if this is important for you.
If you prefer to follow a specific diet, the Mediterranean diet and the Dietary Approach to Stop Hypertension (DASH) diets are great options. They can help lower blood pressure and cholesterol. They will also lower your risk for heart attacks and worsening heart failure.
But keep in mind these are not the only heart-healthy diets out there — they’re just the most researched. There are many ways to incorporate heart-healthy foods into your daily diet.
It’s also helpful to find a weight that feels healthy for your body. People diagnosed with obesity are more likely to have heart failure. But people with very low body weight who have heart failure are at higher risk for dying compared to those at a healthy weight. So staying in a healthy range is important.
Exercising
Regular exercise can help to strengthen the heart, and it can prevent heart failure from getting worse. A good goal is 30 minutes per day, 5 days per week. You might need to slowly work up to that. Even 15 minutes per day can make a difference.
Any type of exercise will help. That includes regular walking. The important thing is to be consistent. If you’re new to exercise, or you have concerns, ask your healthcare provider to help you come up with a plan.
Not smoking
Smoking can worsen heart failure. So quitting is a helpful goal. There are many ways to approach this. Medications, apps, and counseling are all options. And if quitting feels overwhelming, talk with your healthcare provider. They will be able to provide guidance and help to support you in this goal.
Sleep apnea
Sleep apnea is a condition where breathing pauses during sleep. It can put you at risk for heart failure. It may also cause high blood pressure.
If you snore a lot, or if you’re excessively tired during the day, talk to your healthcare provider. They can help you schedule a sleep test to see if you have sleep apnea. And they can recommend the right treatment if you do have it.
Cardiac rehabilitation for heart failure treatment
Cardiac rehabilitation (rehab) is a program with a team of healthcare providers who help you improve your heart health. The team might include:
Doctors
Physician Assistants
Nurses
Physical therapists
Dietitians
Mental health counselors
Cardiac rehab is recommended for many types of heart disease. Recent research shows it can improve how much activity and exercise you are able to do. So it’s a great way to figure out what you need to do on a daily basis to stay well.
Cardiac rehab programs usually include:
A personal physical fitness program
Diet and nutrition education and planning
Education and counseling for emotional well-being and stress relief
Consider asking your provider about cardiac rehab. Insurance companies may have different criteria for coverage. So you might need to check with your health insurance provider as well.
Devices for heart failure treatment
For more advanced cases of heart failure, cardiac devices can improve heart function and help prevent life-threatening complications. Not everyone needs a device. But you may benefit from one of these devices if your symptoms are severe and your heart is weak.
Implanted cardioverter-defibrillator
If your ejection fraction is less than 35%, life-threatening abnormal heart rhythms can occur without warning. An implanted cardioverter-defibrillator (ICD) can protect you against this.
An ICD is a small device that a cardiologist places in the chest under the skin with a minor procedure. It has wires that are connected to the heart, and it continually reads your heart rhythm. If it detects a life-threatening rhythm, the ICD shocks the heart back into a regular rhythm.
Some people need a more specialized device that also works as a pacemaker, like cardiac resynchronization therapy. This helps with heart failure where the heart chambers are not beating together like they should. An electrophysiologist (a cardiologist specializing in heart rhythm problems) will usually implant this type of device.
Ventricular assist device
A ventricular assist device (VAD) is a pump that a surgeon places in your chest. This is a major surgical procedure. A VAD acts as a pump to help the heart push blood forward. The pump is powered by a battery outside the body, which you must carry at all times. This is a big change in lifestyle. So there’s a lot of preparation before and education after the surgery to make sure you learn how to manage the device at home.
Usually VADs are needed when the ejection fraction is 25% or less and symptoms are severe. Some people get a VAD while they’re waiting for a heart transplant.
Procedures for heart failure treatment
A procedure is necessary to implant the above devices. But there are additional procedures that can also be part of heart failure treatment.
Revascularization therapy
As mentioned, sometimes heart failure is caused by coronary artery disease — a condition that causes blockages in heart arteries. In these cases, improving the blood flow to the heart may also improve heart strength. That means that a procedure or an operation might even eliminate the problem.
If you develop heart failure, your provider will likely check to see if there are any blockages in your heart. If so, treatment with a coronary stent or bypass surgery might improve or even reverse the problem.
Heart transplantation
If you have severe heart failure and other treatments don’t help enough, you might be a candidate for a heart transplant. In this procedure, a healthy heart from an organ donor replaces your own. A heart transplant is a major surgery. There are many steps that someone will go through before this treatment option. It’s common to spend months on a waiting list while waiting for a donor heart to become available.
Heart transplantation causes a big change to your lifestyle afterward. People need close medical attention for the rest of their lives. Medications that suppress the immune system are needed after a transplant so the immune system won’t attack the new heart.
Is right-sided heart failure treated differently?
There’s a lot of overlap in the treatment of right and left heart failure. Treatment for both involves addressing the cause of the heart failure in the first place.
One of the main causes of right heart failure is left heart failure. In that case, the treatments may be the same. But other causes of right heart failure may need to be treated differently. These causes and treatments might include:
Pulmonary emboli: These are blood clots in the lungs, which are treated with blood thinners.
Severe lung disease: This may require medication to open up the airways. COPD is a common example.
Pulmonary arterial hypertension: This is high blood pressure in the arteries of the lungs. It’s treated with special medications to relax the walls of those arteries.
The bottom line
Heart failure is usually a chronic condition, meaning that it may never be fully cured. But for many people, treatment can often make it better. But heart failure might get worse, even if someone does everything possible to treat it. This means that treatment may change over time. Close communication with your healthcare providers is important in heart failure. To promote a healthy heart, it’s also important to pay close attention to diet, exercise, and lifestyle.
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