Treating heart failure for lasting health

If you’re one of the millions of Americans living with heart failure, you may wonder why you should even bother following a treatment plan. Your heart has failed so what’s the point?

Despite its name, heart failure actually means your heart isn’t working as well as it should. While there’s no cure, there’s plenty you can do to treat the symptoms, improve your quality of life, and keep your condition from getting worse. Treatment for heart failure may include lifestyle changes, medications, and surgery.

Tweak your lifestyle habits

Your healthcare provider (HCP) will likely advise that you start addressing heart failure with some lifestyle changes.

Follow a heart-healthy diet. The American Heart Association (AHA) recommends eating a variety of nutrient-rich foods. You may have heard the lineup before:

• Lean protein, such as fish and skinless chicken
• Fresh or frozen fruits and vegetables
• Whole grains, like those found in whole-wheat bread and plain oatmeal
• Low-fat dairy
• Nuts and legumes, such as black beans and chickpeas

Eating salt can cause the body to retain excess fluid, and since it’s common for people with heart failure to have fluid retention, you should limit your sodium intake. The AHA has set an ideal limit of 1,500 milligrams of sodium per day; keeping to this amount can help reduce blood pressure. Talk to your HCP about how limiting salt might help improve your heart failure symptoms and what amount of daily sodium you should shoot for. You may be advised to follow certain heart-healthy eating patterns, such as the DASH diet.

You should also consult your HCP on how much liquid you should consume. Too much fluid in your body can make it harder for your weakened heart to do its job. Too little fluid can pose problems, as well.

Maintain a healthy weight. Excess weight raises blood pressure and blood cholesterol, lowers HDL (“good” cholesterol), and puts strain on the heart. If you’re overweight, talk with your HCP about how to incorporate heart-healthy foods into a weight loss plan you can stick with. With your HCP’s okay, aim to make exercise a regular part of your routine. The AHA recommends 30 minutes of moderate-intensity physical activity—brisk walking, water aerobics, or ballroom dancing, for example—at least five days a week.

If you smoke, quit. Cigarettes are bad for everyone, but if you have heart failure, they’re especially toxic. Nicotine temporarily increases your blood pressure and it can block the blood vessels that feed the heart. If you don’t smoke, but live with a smoker, you’re not off the hook, either.

The good news for anyone looking to kick the habit: The benefits to your health begin almost right away. Within half an hour of smoking your last cigarette, your blood pressure and heart rate recover from nicotine-related spikes, according to the AHA and the United States Surgeon General. After a year, your risk of coronary heart disease is cut in half.

Lower your levels of stress. Experts aren’t sure how stress affects your heart, but this much is certain: It can lead to behaviors that are bad for your heart, like smoking, drinking alcohol, and overeating.

Take your medications as prescribed

Depending on the severity of your condition, your treatment plan may include taking medication. Each of the most commonly prescribed drugs for heart failure treats a different aspect of the condition. That means you may be prescribed more than one of the following drugs. Ask your HCP to explain the purpose of any prescription you’re asked to take and how long you can expect to be on it.

Angiotensin-converting enzyme (ACE) inhibitors: Among the benefits of these drugs is that they lower blood pressure and reduce strain on the heart. They do that by inhibiting the production of angiotensin, a chemical that causes blood vessels to narrow. They may also reduce the risk of a future heart attack. Some studies have shown that they lead to improved symptoms, reduced hospitalization, and better survival in some heart failure patients. (Commonly prescribed drugs include captopril, enalapril, fosinopril, lisinopril, perindopril, quinapril, ramipril, and trandolapril.)

Angiotensin II receptor blocks (ARBs): Similar to ACE inhibitors, these drugs also work by blocking the activity of angiotensin. As a result, your blood vessels relax and blood is able to flow more easily. The way they work in heart failure patients is not fully understood, but they serve as an alternative treatment for patients who can’t tolerate ACE inhibitors. (Commonly prescribed drugs include candesartan, losartan, and valsartan.)

Angiotensin-receptor neprilysin inhibitors (ARNIs): A newer class of drugs, ARNIs don’t have a long history as a treatment for heart failure patients. They’re usually prescribed only after more common medications, such as ACE inhibitors and ARBs, have been tried. (A commonly prescribed drug is sacubitril.)

Beta-blockers (beta-adrenergic blocking agents): These drugs are believed to benefit heart failure patients in part by slowing heart rate and lowering blood pressure to decrease the heart’s workload. They also reduce the risk of abnormal heart rhythms and lower one’s chances of dying unexpectedly. (Commonly prescribed drugs include bisoprolol, metoprolol succinate, and carvedilol.)

Isosorbide dinitrate and hydralazine: This combination drug helps relax blood vessels, making it easier for the heart to pump blood. It offers potential benefits for most heart failure patients. Research suggests it’s especially beneficial to African-Americans with heart failure. A study published in 2017 in JACC: Heart Failure found that it lowered the risk of death in African-Americans with advanced heart failure.

Diuretics (a.k.a. water pills): People with heart failure often retain fluid, which makes it harder for the heart to do its job. Cutting back on sodium and limiting your liquids may be enough to help your body eliminate excess fluids. If not, your HCP may prescribe a diuretic. There are three different classes of diuretics:

• Thiazide diuretics (including chlorothiazide, hydrochlorothiazide, and chlorthalidone)
• Loop diuretics (such as furosemide, bumetanide, and ethacrynic acid)
• Potassium-sparing diuretics (such as spironolactone and eplerenone)

Each one works a little differently, so speak with your HCP about which option makes sense for you.

Aldosterone antagonists: A type of diuretic, these drugs work by blocking a hormone called aldosterone, which causes people with heart failure to retain sodium and fluids. They have been shown to help people with severe heart failure live longer. Like some other diuretics, though, they may raise levels of potassium in your body, so your HCP will want to monitor you closely if you are prescribed a diuretic. (Commonly prescribed drugs include spironolactone and eplerenone.)

Consider surgical options if recommended

If you have severe heart failure, your HCP may advise that you get one of the following medical procedures or surgery:

Implantable cardioverter defibrillator (ICD): If you have severe heart failure and have suffered from or are at high risk for sudden cardiac arrest (when the heart suddenly and unexpectedly stops beating), your HCP may recommend an ICD. If so, you’ll undergo surgery, during which an ICD will be placed under the skin of your chest. Its job is to check your heart rate and use electrical shocks to correct any irregular heartbeats.

Cardiac resynchronization therapy (CRT): When both sides of your heart no longer contract at the same time—which is the case for some heart failure patients—the beating of your heart is disrupted. If you have this problem, you may need to have a type of pacemaker called a CRT implanted near your heart.

Angioplasty or coronary artery bypass grafting (CABG): These surgeries are performed when plaque narrows or blocks an artery supplying blood to your heart. An angioplasty involves widening the artery with a small balloon; sometimes a small device called a stent may be inserted to keep the artery open. A CABG involves rerouting an artery (to bypass the blockage) using a piece of blood vessel taken from another part of your body.

Valve surgery: Valves control blood flow through your heart. If one or more valves become damaged or worn down by disease, they may need to be repaired or replaced altogether. Repair is preferable to replacement when possible, and both are done via open-heart surgery.

Left ventricular assist device (LVAD): Your HCP may recommend a procedure in which a mechanical heart pump is surgically implanted to help your weakened heart pump blood out to the rest of your body.

Certain very severe and worsening cases of heart failure may require a heart transplant.