The #1 rule is to stick to your treatment plan.
When it comes to treating heart failure, your commitment goes a long way. “It’s so critically important to survival for [patients] to be taking the medications, to be following up, [and] to be very mindful of their lifestyle modifications,” says Michelle Weisfelner Bloom, MD, cardiologist at Stony Brook University Medical Center.
A 2012 study concluded that the primary reason patients did not have success with heart failure treatment was not adhering to the medication and lifestyle recommendations from their doctors. Not taking medications as prescribed was linked to a lower quality of life, worse heart failure symptoms, and more frequent hospitalizations from heart failure.
“We use medication in heart failure both to make symptoms better [and] improve survival,” says Dr. Weisfelner Bloom.
Certain medications target different aspects of heart failure, and patients may respond better to some options better than others, depending on their personal medical history and heart failure risk factors.
Here are some of the medication options used to treat heart failure.
Beta blockers lower the heart rate, allowing the heart muscle to get stronger. This is typically the first medication a patient with heart failure will start, according to Satjit Bhusri, MD, cardiologist at Lenox Hill Hospital.
Angiotensin-2 receptor blockers and ACE inhibitors both help relax the blood vessels to “decrease blood pressure and increase the amount of blood that’s getting pumped forward to the body,” says Dr. Weisfelner Bloom.
Valsartan/sacubitril is a drug combination that has been shown to decrease mortality from heart failure, according to Dr. Bhusri. “Valsartan is a relative of an ACE inhibitor. Sacubitril is a brand new class of medications,” says Dr. Bhusri. “It’s actually a hormone that’s released by the top of your heart to help patients unload the pressures of their heart, almost like a diuretic.”
Diuretics treat fluid retention to reduce symptoms. By increasing frequency of urination, diuretics lower the amount of fluid in the body. This is helpful since fluid retention is a common problem with heart failure.
Aldosterone antagonists block receptors that can cause fluid retention, scarring, and abnormal heart rhythms. Unlike diuretics, these drugs can help the body get rid of water without losing potassium, according to the American College of Cardiology.
Hydralazine and isosorbide dinitrate is a combination of drugs that’s specifically helpful for African Americans with heart failure. “We have multiple studies out there that [have] shown that it not only improves overall pumping of the heart, but it also reduces your risk of death,” says Rachel Bond, MD, cardiologist at Lenox Hill Hospital.
“People think of heart failure as a condition that’s ‘doom and gloom,’” says Nieca Goldberg, MD, medical director at NYU Langone Health, Joan H. Tisch Center for Women’s Health. “That’s not the way it is anymore because we have multiple medications that can work to improve symptoms and in some cases improve heart muscle function.”
For more tips on managing heart failure:
- Here are tips for exercising with heart failure.
- Check out how to eat less salt for a heart-healthy diet.
- Learn more about lifestyle changes for heart failure.
Dr. Bloom is an associate professor of medicine at Stony Brook University Medical Center, a fellow of the American College of Cardiology, and a fellow of the Heart Failure Society of America.Satjit Bhusri
Dr. Bhusri is an attending cardiologist at the Lenox Hill Heart & Vascular Institute and an assistant professor of cardiology at Hofstra Northwell School of Medicine.Rachel Bond
Dr. Bond is a cardiologist and associate director of the Women's Heart Health Program at Northwell Health, Lenox Hill Hospital and an assistant professor of cardiology at Hofstra Northwell School of Medicine.Nieca Goldberg
Dr. Goldberg is a cardiologist and medical director of the NYU Langone Health Joan H. Tisch Center for Women’s Health.
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We use medications in heart failure,
both to make symptoms better, but
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also improve survival with heart failure.
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When a patient comes
with a heart failure,
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the first medication we always
put on board is a beta blocker.
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A beta blocker's very important, why?
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It lowers the heart rate and, therefore,
forcing your heart muscle to get stronger.
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So a beta blocker is our
number one medication.
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Angiotensin receptor blockers or
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ACE inhibitors are used to relax the blood
vessels to decrease blood pressure and
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increase the amount of blood that's
getting pumped forward to the body.
00:00:41,080 --> 00:00:42,790
So there's a new medication now.
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It's the first medication that has
shown to decrease mortality in patients
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with systolic heart failure that is
a combination of Valsartan and Sacubitril.
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Valsartan is a relative
of an ACE inhibitor.
00:00:58,620 --> 00:01:01,540
Sacubitril is a brand
new class of medication.
00:01:01,540 --> 00:01:07,150
And it's actually a hormone that's
released by the top of your heart
00:01:07,150 --> 00:01:12,180
to help patients unload the pressures
of their heart, almost like a diuretic.
00:01:12,180 --> 00:01:16,770
Diuretics have never been proven to
increase survival in heart failure, but
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they certainly can make
patients feel better.
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They do that by increasing
the amount that a patient urinates.
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So if more urine goes through the kidney,
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you're decreasing the level
of fluid in the body, and it
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eliminates the fluid retention that a lot
of patients with heart failure experience.
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We also use aldosterone antagonists,
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which work by blocking one of
the receptors in the body that generally,
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in a heart failure state, can cause fluid
retention and scarring and arrhythmia.
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Now, in a set class of patients,
particularly African Americans,
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they may benefit from a combination pill,
which is Hydralazine and nitrates.
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And it's very important that,
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if you are African American that you be
started on these additional medications
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because we have multiple studies out there
that has shown that it not only improves
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overall pumping of the heart, but it also
reduces your risk of death, for example.
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critically important to survival for
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that patient to be taking the medications,
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to be following up, to be very mindful
of their lifestyle modifications.
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I think people think of heart failure
as a condition where it's doom and gloom.
00:02:27,720 --> 00:02:29,906
And you're just gonna be bedridden.
00:02:29,906 --> 00:02:34,450
And that's not the way it
is anymore because we have
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multiple medications that can
work to improve symptoms and
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in some cases,
improve heart muscle function.
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Da Silva AF, Cavalcanti ACD, Malta M, Arruda CS, Gandin T, da Fe A, Rabelo-Silva ER. Treatment adherence in heart failure patients followed up by nurses in two specialized clinics. Rev Lat Am Enfermagem. 2015 Sep-Oct;23(5):888-94.
Golwala HB, Thadani U, Liang L, Stavrakis S, Butler J, Yancy CW, et al. Use of hydralazine-isosorbide dinitrate combination in African American and other race/ethnic group patients with heart failure and reduced left ventricular ejection fraction. J Am Heart Assoc. 2013.
Heart failure: aldosterone receptor antagonists. Washington, DC: American College of Cardiology. (Accessed on February 15, 2021 at https://pubmed.ncbi.nlm.nih.gov/16373465/)Medications used to treat heart failure. Dallas, TX: American Heart Association. (Accessed on February 15, 2021 at http://www.heart.org/HEARTORG/Conditions/HeartFailure/TreatmentOptionsForHeartFailure/Medications-Used-to-Treat-Heart-Failure_UCM_306342_Article.jsp#.WtjeGpM-fVo.)