The cornerstone of long-term heart failure treatment, particularly for heart failure with reduced ejection fraction (HFrEF), involves a combination of medications focused on improving heart function and reducing symptoms.
Core Medications for Long-Term Heart Failure Management
These medications are generally prescribed long-term and aim to improve survival and quality of life:
-
ACE Inhibitors (or ARBs/ARNIs): Angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), or angiotensin receptor-neprilysin inhibitors (ARNIs) help relax blood vessels, making it easier for the heart to pump blood. These are often the first-line treatment.
-
Beta-Blockers: These medications slow the heart rate and lower blood pressure, reducing the workload on the heart.
-
Mineralocorticoid Receptor Antagonists (MRAs) (Aldosterone Antagonists): Such as spironolactone or eplerenone, these medications help reduce fluid retention and prevent scarring of the heart muscle. They are typically added if the patient remains symptomatic despite ACE inhibitors/ARBs/ARNIs and beta-blockers.
Additional Medications and Therapies
Depending on the individual's specific condition and symptoms, other treatments may also be part of the long-term management plan:
-
Diuretics: These medications help the body get rid of excess fluid, reducing swelling and shortness of breath. However, they primarily address symptoms and don't improve long-term survival.
-
Digoxin: This medication can help strengthen the heart's contractions and control heart rate, particularly in patients with atrial fibrillation. It's often used to manage symptoms but doesn't affect mortality.
-
SGLT2 Inhibitors: Originally developed for diabetes, these medications have been shown to improve outcomes in heart failure patients, even those without diabetes.
-
Hydralazine and Isosorbide Dinitrate: This combination is particularly beneficial for African Americans with heart failure who don't tolerate ACE inhibitors or ARBs.
-
Implantable Devices: In certain cases, devices like implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT) devices may be recommended to prevent sudden cardiac death or improve the coordination of heart contractions.
Lifestyle Modifications
Lifestyle changes are also crucial for managing heart failure long-term:
- Diet: A low-sodium diet is essential to reduce fluid retention.
- Exercise: Regular, moderate exercise can improve heart function and overall health.
- Weight Management: Maintaining a healthy weight reduces the strain on the heart.
- Smoking Cessation: Smoking damages the heart and blood vessels.
- Alcohol Limitation: Excessive alcohol consumption can worsen heart failure.
- Fluid Restriction: May be necessary in some cases to manage fluid overload.
Regular Monitoring and Follow-Up
Long-term heart failure management requires regular monitoring by a healthcare professional to adjust medications as needed and manage any complications. This includes regular check-ups, blood tests, and echocardiograms.
