By Shamard Charles, MD, MPH 

 Medically reviewed by Anthony Pearson, MD

Heart failure is a chronic condition that, if untreated, typically gets progressively worse over time. With advances in medical technology and more knowledge about how heart failure develops, most people no longer receive one-size-fits-all treatment for heart failure.

A combination of aggressive lifestyle changes and medical care aimed at optimizing your cardiac function and minimizing your symptoms can stop heart failure in its tracks and even reverse it.

This article will discuss heart failure, how it can be prevented or reversed, and the outlook for people with the condition.

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What Is Heart Failure?

Heart failure occurs when the heart fails to adequately perform its job of pumping blood throughout the body. As a result, the body's tissues and organs may not get enough nutrients and oxygen.

The body's typical response to heart failure is to cause sodium retention and excess fluid buildup (accumulation). This leads to swelling of the lower extremities (edema) and lung congestion. In these cases, heart failure is commonly referred to as congestive heart failure (CHF).

Causes

Heart failure can be caused by direct or indirect damage to the heart. Typically, conditions that damage the heart must be well managed for your heart to stay strong and pump blood efficiently throughout your body. The following conditions most commonly cause heart failure:1

• Coronary artery disease: Deposits of fat, cholesterol, calcium, and cell debris (atherosclerotic plaques) can narrow the diameter of your blood vessels, limiting the amount of blood that can pass through your heart at any given time. Narrow vessels can lead to heart failure, heart attack, and stroke if a piece of plaque breaks off from one vessel and lodges in another.

• Prior heart attack: In a heart attack (myocardial infarction), blood flow is cut off in a coronary artery. Heart attacks damage the heart, weakening the muscle and compromising its ability to pump blood effectively throughout the body.

• Hypertension: High blood pressure forces the heart to work harder than it normally would. Over time, heart failure may develop.

• Obesity: Obesity is often associated with type 2 diabetes and sleep apnea. Both conditions are independent risk factors for heart disease. Obesity can force the heart to work harder than it normally would. If you have obesity, you are also more likely to have high cholesterol levels, which increases your risk of a buildup of plaque in the arteries (atherosclerosis) and heart disease.

• Diabetes: Uncontrolled heart blood sugar (glucose) levels are toxic to the heart, nerves, and blood vessels. People with diabetes also tend to have higher rates of obesity and hypertension, which are independent risk factors for CHF.

• Valvular heart disease: Damaged heart valves compromise the heart's ability to deliver blood to the rest of the body, leading to CHF.

• Hyperthyroidism (overactive thyroid): Too much thyroid hormone can raise blood pressure and heart rate. When the heart beats too quickly, it does not allow the heart time to fill up with blood. High blood pressure is an independent risk factor for heart failure and puts stress on the heart.

• Alcohol: Excessive alcohol consumption can damage the heart muscle. This condition is called alcoholic cardiomyopathy and it is a form of dilated cardiomyopathy.2

• Viral myocarditis: Inflammation of the heart muscle can occur after a viral illness and lead to heart failure.3

• Inherited heart diseases: Certain inherited conditions, such as familial dilated cardiomyopathy and familial hypertrophic cardiomyopathy, can lead to heart failure.45

• Infiltrative disease: In some medical conditions, substances (e.g., abnormal protein or iron) are deposited in the heart tissue and can lead to heart failure.6

• Other conditions: A lack of healthy red blood cells to move oxygen throughout the body (severe anemia) and abnormal heart rhythms (arrhythmias) can develop for different reasons. No matter the cause, these conditions limit the amount of oxygenated blood that reaches your organs.

Can Heart Failure Be Reversed?

Heart failure typically gets worse over time if it's not untreated. However, research has shown that medical therapy can strengthen the heart. True reversal of heart failure comes from optimizing the powerful medical therapy that has been developed over the last 40 years.

For some people who fail to respond to these treatments, procedures ranging from special pacemakers to open-heart surgery might be considered.

How Is Heart Failure Reversed?

The following strategies can be used to try to reverse heart failure.

Medication

Coupling heart-healthy lifestyle habits with medication and strict blood pressure and blood sugar control can lead to greater reversals of your heart failure symptoms.

You and your cardiologist will determine the best treatment plan for you based on the type of heart failure you have, the severity of the condition, and the possible side effects of treatment. They will also explain how to take the medication, specifically how often and in what dosage.

If you are diagnosed with heart failure with reduced ejection fraction (HFREF), you are likely to be prescribed one of four very effective medications: beta blockers, renin-angiotensin blockers, diuretics (specifically, spironolactone), and sodium-glucose cotransporter-2 (SGLT2) Inhibitors. These medications can help improve your heart’s function.

Not only have medications in these four drug classes been shown to improve heart pump function, but they also reduce hospitalizations and can help reduce your risk of dying from heart failure.

Beta Blockers

Three beta blockers—Coreg (carvedilol), Toprol (metoprolol succinate), and Zebeta (bisoprolol)—have been proven to be effective in reducing symptoms, readmissions, and mortality in people living with chronic HFrEF.7

There is no consensus on the exact mechanism of action behind the effectiveness of beta blockers, but one pathway shows that they are particularly effective at reversing the neurohumoral effects of the sympathetic nervous system that often contribute to damage and weakening of the heart.

Side effects of beta blockers include fatigue, lightheadedness, weight gain, cold hands and feet, and difficulty sleeping.7

Renin-Angiotensin System Blockers

The renin-angiotensin system regulates blood pressure through a group of related hormones that influence each other and work together with the kidneys. Drugs that affect this system can be used in heart failure.

Angiotensin-Converting Enzyme Inhibitors (ACE Inhibitors)

Over time, angiotensin can damage the heart and worsen the organ's ability to pump blood effectively throughout the body. ACE inhibitors block the action of angiotensin, an enzyme that narrows heart vessels and forces the heart to work harder. They also widen blood vessels which allows blood to flow more freely in the heart.

ACE inhibitors also reduce the production of angiotensin II, which signals the release of blood-pressure-raising hormones. Side effects of these drugs include fatigue, headache, chronic cough, and dizziness from a drop in blood pressure. 

Angiotensin II Blockers (ARBs)

ARBs work similarly to ACE inhibitors and block angiotensin II from attaching to angiotensin II receptors. This helps lower blood pressure as well as the likelihood of damage occurring to the heart, blood vessels, and kidneys. The side effects of these drugs include dizziness, angioedema, and a rise in potassium blood levels (hyperkalemia). 

Of note, Entresto (sacubitril/valsartan)—a combination of a neprilysin inhibitor and an ARB—has been shown to reduce morbidity and mortality in people living with chronic heart failure with reduced ejection fraction.8 

Spironolactone 

Aldactone (spironolactone) is a diuretic (or "water pill) that blocks the activity of aldosterone, a hormone produced by the adrenal gland that helps regulate water and sodium levels in the body.

Sodium Glucose Cotransporter 2 (SGLT-2)

Jardiance (empagliflozin), a diabetes drug in the SGLT-2 inhibitor drug class, has been shown to treat diabetes as well as reverse heart failure in both people living with diabetes and people who do not have diabetes.

Farxiga (dapagliflozin) has also been shown to reduce the risk of cardiovascular death and hospitalization for heart failure, but not reverse heart failure.9

Other Medications

Managing any underlying health conditions you have is a mainstay of therapy and is key to relieving your heart failure symptoms. No studies have shown that high blood pressure medications (e.g., beta-blockers, anti-diuretics, and mineralocorticoid receptor antagonists), antiarrhythmic, or antithyroid medications can undo the damage of heart failure.

However, these drugs can provide a huge benefit to you—directly and indirectly—by decreasing your risk of heart attack and stroke, regulating your heart rhythm, lessening the load on your heart, and making it easier for your heart to beat and pump blood throughout your body.

Taking a baby aspirin (81 milligrams) per day used to be a mainstay therapy because of the drug's ability to prevent blood clots. It was thought that taking daily baby aspirin would prevent heart failure and even reverse it, but more recent research has called this claim into question.10

Surgery

Surgical treatments like heart transplantation can greatly improve your quality of life and may help you live longer, especially when combined with a heart-healthy lifestyle.11 

If the left side of your heart is damaged or not pumping the way it should, cardiac resynchronization therapy (CRT) can help your left ventricle contract more normally. In more severe cases, a left ventricular assist device (LVAD)—a mechanical pump that maintains the heart's pumping ability—can help reverse heart failure symptoms.11

Lifestyle Changes 

The following lifestyle changes are recommended for people living with heart failure:12

• Follow a diet similar to the Dietary Approaches to Stop Hypertension (DASH) diet or Mediterranean diet. These diets contain lots of fresh fruits and vegetables, are low in sodium, and are high in potassium. In general, high sodium intake should be avoided.

• Excess weight strains the heart and is a major contributor to high blood pressure. Losing enough weight through a combination of diet and exercise and maintaining a body weight with a body mass index (BMI) under 30 can be beneficial.

• Getting a total of 150 minutes per week of moderate-to-vigorous exercise per week has substantial health benefits and aids in weight management.13

• Weigh yourself daily and tell your healthcare providers if your goes up or down by 3 pounds compared to your baseline weight.

How to Prevent Heart Failure

The best way to prevent heart failure and CHF is to follow the heart-healthy guidelines set by the American Heart Association (AHA) and the U.S. Preventive Services Task Force (USPSTF), which call for following a low-sodium diet with plenty of fruits and vegetables, regular exercise (preferably five 30-minute, sweat-breaking sessions per week), no smoking, and limiting alcohol intake.14

Outlook

Heart failure used to be associated with very high morbidity and mortality. With current treatments, most people living with heart failure can improve and engage in normal daily activities and have a longer lifespan.

There is hope with better treatments. Guidelines to treat heart failure with reduced ejection fraction have reduced hospitalizations and the risk of cardiovascular death by up to 62% compared to limited conventional therapy.15

Symptoms of advanced heart failure are signs of very low cardiac output. The following signs can mean that someone is dying of heart failure—especially if frequent hospitalizations and specialized treatment regimens are not helping them get better:

• Feeling full after not eating much (early satiety)

• Poor appetite

• Abdominal pain

• Nausea

• Coughing up pink sputum

• Renal insufficiency

• Forgetfulness and memory problems

Summary 

Heart failure typically gets worse over time. However, research has shown that combing surgery, medications, and aggressive lifestyle changes can strengthen the heart and potentially reverse heart failure. Ultimately, your outlook will depend on your overall health, medication compliance, and the way your body responds to treatment. 

15 Sources

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Johns Hopkins Medicine. Alcohol and Heart Health: Separating Fact From Fiction.

Sozzi FB, Gherbesi E, Faggiano A, et al. Viral myocarditis: classification, diagnosis, and clinical implications. Front Cardiovasc Med. 2022;9:908663. doi:10.3389/fcvm.2022.908663

Mestroni L, Brun F, Spezzacatene A, Sinagra G, Taylor MR. Genetic causes of dilated cardiomyopathy. Prog Pediatr Cardiol. 2014;37(1-2):13-18. doi:10.1016/j.ppedcard.2014.10.003

National Library of Medicine, MedlinePlus. Familial Hypertrophic Cardiomyopathy.

Bejar D, Colombo PC, Latif F, Yuzefpolskaya M. Infiltrative cardiomyopathies. Clin Med Insights Cardiol. 2015;9(Suppl 2):29-38. doi:10.4137/CMC.S19706

Masarone D, Martucci ML, Errigo V, Pacileo G. The use of β-blockers in heart failure with reduced ejection fraction. J Cardiovasc Dev Dis. 2021;8(9):101. doi:10.3390/jcdd8090101

Solomon SD, Vaduganathan M, L Claggett B, et al. Sacubitril/valsartan across the spectrum of ejection fraction in heart failure. Circulation. 2020;141(5):352-361. doi:10.1161/CIRCULATIONAHA.119.044586

Food and Drug Administration. FDA Approves New Treatment for a Type of Heart Failure.

De Caterina R. Aspirin in heart failure: don't throw the baby (aspirin) out with the bathwater. Eur J Heart Fail. 2017;19(9):1089-1094. doi:10.1002/ejhf.894

American Heart Association. Devices and Surgical Procedures to Treat Heart Failure.

White MF, Kirschner J, Hamilton MA. Self-care guide for the heart failure patient. Circulation. 2014;129(3):e293–e294. doi:10.1161/circulationaha.113.003991

U.S. Preventive Services Task Force. Healthy Diet and Physical Activity for Cardiovascular Disease Prevention in Adults with Cardiovascular Risk Factors: Behavioral Counseling Interventions.

National Heart, Lung, and Blood Institute. Heart Failure.

Tsao CW, Aday AW, Almarzooq ZI, et al. Heart disease and stroke statistics-2022 update: a report from the American Heart Association. Circulation. 2022;145(8):e153-e639. doi:10.1161/CIR.0000000000001052

By Shamard Charles, MD, MPH
Shamard Charles, MD, MPH is a public health physician and journalist. He has held positions with major news networks like NBC reporting on health policy, public health initiatives, diversity in medicine, and new developments in health care research and medical treatments.