Medications for Heart Failure: Understanding Your Options

The #1 rule is to stick to your treatment plan.

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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.”

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