Congestive Heart Failure (CHF) Treatment Options

Congestive heart failure (CHF), sometimes simply called heart failure, happens when the heart doesn’t pump blood as it should, causing fluid to build up in your body. There’s no cure for CHF, but treatment options are available.

The treatment plan your healthcare provider suggests can vary based on the stage and cause of your CHF. Your healthcare team will likely include a cardiologist, a doctor who specializes in conditions of the heart.

The range of treatment options for CHF typically includes medications, therapies, procedures, and surgeries.

Prescription medications are first-line treatment options for congestive heart failure, meaning they’re typically tried before any surgeries or other procedures. Medications are not a cure, but they can help manage symptoms. You may need to take them for the rest of your life.

Angiotensin-Converting Enzyme (ACE) Inhibitors and Angiotensin Receptor Blockers (ARBs)

Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) help lower blood pressure, making it easier for your heart to pump blood.

ACE inhibitors widen blood vessels and reduce how hard your heart needs to work, which helps prevent CHF from worsening. Some common ACE inhibitors include:

• Prinivil, Zestril (lisinopril)
• Vasotec (enalapril)
• Tritace (ramipril)

Side effects of ACE inhibitors may include angioedema (swelling under your skin), a dry cough, edema (swelling), high potassium levels, decreased kidney function, and low blood pressure.

ARBs work similarly, and researchers have found they may be less likely to cause side effects like angioedema or cough. Some common ARBs include: 

• Cozaar (losartan)
• Diovan (valsartan)
• Blopress, Atacand, Amias, Ratacand (candesartan)

Like ACE inhibitors, ARBs can cause a decline in kidney function and blood pressure.

Angiotensin-Receptor Neprilysin Inhibitors (ARNIs)

ARNIs are a combination of two drugs: a neprilysin inhibitor and an ARB.

A neprilysin inhibitor helps decrease stress on your heart by stopping an enzyme called neprilysin from breaking down substances in your body that help relax blood vessels. Entresto (sacubitril/valsartan) is an ARNI.

Side effects of ARNIs include cough, a decline in blood pressure and kidney function, and increased blood potassium levels.

Beta-Blockers

Beta-blockers slow down the heart and lower blood pressure, which can help reduce strain on the heart. These drugs block the effects of adrenaline, a hormone that makes the heart pump harder and faster.

Some common beta-blockers for CHF include: 

• Coreg (carvedilol)
• Cardicor, Congescor (bisoprolol)
• Toprol-XL (metoprolol succinate)

Side effects may include a slow heart rate and low blood pressure. Other side effects are fatigue, dizziness, constipation, and nausea.

I(f) Channel Blockers

An I(f) channel blocker such as Corlanor (ivabradine) is another option for managing CHF, usually when beta blockers don’t fully control heart rate. By slowing the heart down, this medication allows the heart to pump more efficiently, reducing symptoms like fatigue and shortness of breath.

Side effects can include a slow heart rate, atrial fibrillation, high blood pressure, and vision issues.

SGLT-2 Inhibitors

SGLT-2 inhibitors were originally designed to help manage diabetes but are now known to benefit CHF patients as well.

These medications help the body remove excess glucose (sugar) through urine, which also helps reduce blood pressure and body weight. SGLT-2 inhibitors can improve CHF symptoms and reduce CHF-related mortality risk. The exact mechanism of how these drugs do that is unknown, but it may lighten the heart’s workload.

Jardiance (empagliflozin) and Farxiga (dapagliflozin) are two examples of SGLT-2 inhibitors.

Potential side effects can include fungal infections in the genital areas, a severe urinary tract infection that spreads to the kidneys (called urosepsis), and lowered kidney function.

Hydralazine and Isosorbide Dinitrate

Apresoline (hydralazine) and Isordil (isosorbide dinitrate) help widen blood vessels to allow blood to flow more easily through your body. Research suggests these medications may be especially beneficial for people of African ancestry.

These medications are sometimes used in combination with ACE inhibitors or ARBs but can be used alone when these drugs are not an option.

Side effects of hydralazine include headache, loss of appetite, vomiting, and rash or flushing. Common side effects of isosorbide are headache and nausea.

Diuretics (Water Pills)

Diuretics help the body eliminate excess fluid by making the kidneys remove more salt and water through urine. This helps reduce fluid buildup in the lungs, ankles, and legs. Different diuretics work at various rates to remove fluid.

Commonly prescribed diuretics for CHF include: 

• Lasix (furosemide)
• Aquazide, Microzide, Oretic (hydrochlorothiazide)
• Bumex (bumetanide)
• Demadex (torsemide)

Potential side effects include dehydration, increased thirst, frequent need to urinate, headache, weakness, and fatigue.

Other Medications

Depending on your specific needs, your healthcare providers may prescribe additional medications:

• Anticoagulants (blood thinners): Can help if you also have atrial fibrillation or a high risk of blood clots
• Cholesterol-lowering medications: Help reduce the risk of heart attack or stroke by preventing plaque buildup in arteries
• Digoxin: May be prescribed to strengthen the heart’s contractions and slow your heart rate
• Calcium channel blockers: Help the heart muscles relax, lowering blood pressure and improving blood flow
• Potassium supplements: May be necessary if diuretics or other medications cause low potassium levels
• Oxygen (or oxygen therapy): Can help improve breathing and energy levels in severe cases

Your healthcare team may also recommend rehabilitation therapy to improve your heart health and overall well-being.

This type of therapy involves a combination of medical evaluation, personalized exercise, nutrition counseling, and education about CHF and the importance of taking your medication as prescribed. Cardiac rehab can help slow and, in some cases, reverse the progression of CHF.

In some cases, you may need medical devices or surgery to help manage your symptoms. Your healthcare provider may suggest procedures or implanted devices such as:

• Biventricular pacemaker: Also known as cardiac resynchronization therapy (CRT), a pacemaker helps both sides of your heart contract and relax in sync, improving how well your heart pumps blood. This procedure can significantly reduce symptoms like shortness of breath and fatigue.
• Mechanical heart pump: A ventricular assist device (VAD) is a battery-operated device that helps the heart circulate blood more effectively. It can be used as a temporary solution while waiting for a heart transplant, or it may serve as a long-term treatment option for those who aren’t eligible for a transplant.
• Implantable cardioverter defibrillator (ICD): This device monitors your heart’s rhythm and delivers electrical pulses to correct dangerous arrhythmias. It helps prevent sudden cardiac arrest by restoring a normal heartbeat if your heart goes into a life-threatening rhythm.
• Heart surgery: Procedures such as valve repair or coronary artery bypass grafting can improve heart function and alleviate symptoms. These may be necessary to repair a congenital heart defect or fix damage to the heart from a heart attack or other conditions.
• Heart transplant: Some people will need a transplant if CHF becomes life-threatening and other treatments aren’t effective. During this procedure, surgeons replace your heart with a healthy donor heart.

The American Heart Association does not endorse any particular complementary and alternative therapies (CAMs) for CHF but acknowledges that some people may try these remedies. Some may even be effective, while others are known to be dangerous.

Omega-3 fatty acids, yoga, and tai chi may offer benefits, but their effects on treating CHF are not fully proven. Other alternatives, such as some plants, herbs, and high doses of vitamin E, may be harmful to people with CHF and potentially worsen symptoms or interact poorly with heart medications.

Shared decision-making between you and your healthcare providers is key when considering complementary treatments. Always consult your provider before using complementary products to ensure they’re safe for your condition.

Lifestyle changes can help you manage CHF, slow its progression, and improve your daily life. Here are some actions you can take:

• Monitor your weight to detect fluid retention
• Avoid smoking to maintain or improve your heart health
• Work with your healthcare provider to develop a treatment plan to stay physically active and strengthen your heart
• Get enough rest throughout the day to ease symptoms
• Manage stress through relaxation techniques, such as meditation and breathing exercises
• Limit how much salt you eat, which may also help prevent excess fluid buildup

CHF progression can happen quickly, or it may occur slowly over time. Even though there isn’t a cure yet, many people can live fulfilling lives with heart failure if they manage it well.

According to some research, people with CHF may experience a loss of about seven years in life expectancy compared to people without CHF. Early treatment and proper management of CHF and other health conditions can help improve these outcomes.

After a heart failure diagnosis, many people learn to manage symptoms and build habits to support their heart health. Good habits for living with heart failure include eating nutritious foods, tracking your CHF symptoms, and exercising as recommended. Staying in contact with your healthcare provider is also vital.

Reach out to friends, family, and healthcare providers for support. As your symptoms improve, reconnect with activities that bring you joy, and set personal goals for managing your condition.