Treatment for Heart Failure: A GoodRx Guide to Medications and More

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

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.

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.

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Written by:

Sarah A. Samaan, MD

Sarah Samaan, MD, FACC, FACP, FASE is a board-certified cardiologist who practiced clinical cardiology for nearly 30 years. She is a member of the American College of Cardiology and the American College of Physicians, among others.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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