By Shamard Charles, MD, MPH 

Updated on August 04, 2022

 Medically reviewed by Richard N. Fogoros, MD

Heart disease cannot be cured, but survival and quality of life with heart failure can be improved with medical treatment, lifestyle modifications, and sometimes specialized surgical procedures.

Prescription medications, such as beta-blockers, angiotensin-receptor neprilysin inhibitors (ARNIs), and diuretics, are commonly used to treat heart failure. 

When medications aren't enough to manage symptoms, or when a problem like an arrhythmia or heart valve disease is the cause of heart failure, procedures such as valve replacement, a pacemaker, or other interventions may be necessary for some people.

This article will review the common medications and other treatment options that are commonly used in the management of heart failure.

Heart Failure Medications

Prescription medications are the most effective treatments for the management of heart failure. These medications often have to be adjusted periodically as the disease progresses.

The optimal therapy of heart failure typically requires combining several kinds of medications whenever possible.¹

Beta-Blockers

Beta-blockers are used for heart failure because they slow down the heart rate. This allows the heart to fill more completely before pumping, providing the body with more blood each heartbeat. This helps alleviate some of the fatigue you can experience due to heart failure. 

Examples include:¹

• Coreg (carvedilol)

• Coreg CR (carvedilol controlled-release)

• Toprol XL (metoprolol succinate)

• Zebeta (bisoprolol)

Diuretics

Diuretics are medications that act on the kidneys and promote the elimination of water and excess sodium from the body. This relieves the edema and shortness of breath of heart failure, as both of these symptoms result from fluid buildup in the body.

Commonly used diuretics include:¹

• Bumex (bumetanide)

• Demadex (torsemide)

• Lasix (furosemide)

• Esidrix (hydrochlorothiazide)

• Diuril (chlorothiazide)

• Chlorthalidone

• Lozol (indapamide)

• Zaroxolyn (metolazone)

Potassium levels can become low with diuretic use, so mineral supplementation may be required.

Angiotensin-Converting Enzyme (ACE) Inhibitors

These medications work to relax the blood vessels to lower the pressure your heart has to pump against. The most common ACE inhibitors used in heart failure include:¹

• Capoten (captopril)

• Monopril (fosinopril)

• Prinivil and Zestril (lisinopril)

• Vasotec (enalapril)

• Accupril (quinapril)

• Aceon (perindopril)

• Altace (ramipril)

• Mavik (trandolapril)

Angiotensin II Receptor Blockers (ARBs)

ARBs also work by lowering blood pressure, which reduces the strain on the heart. They are similar to ACE inhibitors in mechanism and effectiveness but have fewer side effects. Examples of ARBs include:¹

• Atacand (candesartan)

• Benicar (olmesartan)

• Cozaar (losartan)

• Diovan (valsartan)

• Micardis (telmisartan)

Aldosterone Antagonists

Aldosterone antagonists, such as Aldactone (spironolactone) and Inspra (eplerenone), block the action of a hormone called aldosterone and remove fluid from the body. They are known as "potassium-sparing" because they prevent the potassium level in the body from becoming too low.²

Hydralazine

Hydralazine in combination with nitrates works to dilate (expand) arteries, lowering blood pressure. This prevents the worsening of heart failure by reducing the strain on the heart. 

Angiotensin-Receptor Neprilysin Inhibitors (ARNIs)

Entresto combines valsartan, an ARB inhibitor, and an agent called sacubitril. Sacubitril inhibits the enzyme neprilysin, causing an increase in levels of natriuretic peptides, which help regulate blood pressure, as well as salt and fluid levels.³

Entresto is still a relatively new treatment for heart failure, and its effect in comparison to the more established medications, as well as its long-term side effects, are not fully understood yet. 

Dopamine

By making the heart beat more forcefully, dopamine helps it circulate oxygen-rich blood more efficiently. Dopamine also increases the amount of urine the body produces, which helps get rid of the extra fluid building up in the lungs, arms, and legs. 

Interestingly, unlike many of the other medications used for heart failure that lower blood pressure, dopamine raises blood pressure. In some circumstances, this effect is helpful because low blood pressure may occur in heart failure.

Dopamine is an intravenous (IV) drug and is generally reserved for treating advanced heart failure. However, it can be especially useful in premature babies and infants with other heart problems. It can boost babies' heart rates and blood pressure, significantly improving their chances of survival.⁴

Dopamine shouldn't be taken with beta-blockers, which lengthen and strengthen the normal effect of dopamine.

Other Heart Failure Medications

Heart failure is a complex condition that may require using older classes of drugs to lessen your symptoms. The following drugs may be used on a case-by-case basis if you are experiencing worsening symptoms that are not getting better with the aforementioned medications:

• Lanoxin (digoxin): Digoxin, also called digitalis, is used to help a weak heart pump more efficiently. Digoxin strengthens the force of the heart muscle's contractions and, in low doses, helps restore a normal, steady heart rhythm. Some cardiologists (doctors who specialize in heart disorders) have been reluctant to prescribe digoxin because long-term use can cause arrhythmias.

• Vasodilators: Vasodilators are a mainstay in managing acute heart failure, particularly when accompanied by high blood pressure. Vasodilators promote the flow of blood by widening blood vessels. Currently available medications include Rectiv, Nitro-Time, Nitrolingual (nitroglycerin), Nitropress (nitroprusside), and Natrecor (nesiritide).

• Calcium channel blockers (CCB): CCBs may be used in acute heart failure due to high blood pressure when other blood pressure medications are not effective. Of note, they should be avoided in people who have heart failure with reduced ejection fraction (HFrEF).

• Statins: Statins are cholesterol-lowering drugs that may reduce the risk of coronary artery disease, a major risk factor for heart failure. The higher your baseline low-density lipoprotein (LDL) levels are, the higher your risk is of experiencing a cardiovascular event such as a heart attack or stroke. Therefore, the strength and type of statin you take will depend on the severity of your hyperlipidemia (blood with too many lipids, or fats) and how your body responds to the medication. Statins are not recommended solely for the treatment of heart failure.

• Blood thinners: Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that can prevent blood clotting. Although aspirin is not used specifically for heart failure, it may be used for certain related conditions. Historically a low dose (an 81-milligram dose called baby aspirin) has been recommended to reduce the risk of heart attack and stroke in high-risk people. Still, the efficacy of this practice has been questioned in recent reports. 

• Nitrates: Nitrates are a type of vasodilator used in the treatment of acute heart failure. Nitrates work by decreasing left ventricular filling pressure (pressure on the left side of the heart) and systemic vascular resistance (the pressure that counters blood flow), while also modestly improving the amount of blood pumped by the heart (cardiac output).

Lifestyle Changes

If you have heart failure, lifestyle adjustments are an absolutely necessary aspect of managing your condition. While these changes cannot cure heart failure, they can help improve your quality of life. Not following these lifestyle recommendations is associated with worsening of the symptoms of heart failure and progression of the disease itself. 

Reducing Salt

Eating salt causes the body to retain more fluid. This is not a problem for healthy people, as the body can rebalance and eliminate any excess fluid and salt fairly efficiently.

However, if you have heart failure or kidney disease, this doesn't happen as efficiently as it should—increasing your chances of fluid accumulation.⁵ Many people with heart failure notice that symptoms of swelling and shortness of breath worsen with increased salt intake.

The American Heart Association recommends an ideal limit of 1,500 milligrams of sodium per day for most people,⁶ but ask your healthcare provider or dietitian how much salt you can consume on a daily basis. The best ways to cut salt intake include avoiding canned or processed foods and not using table salt.

A heart-healthy diet is also important for preventing heart failure from developing or getting worse, because coronary artery disease (CAD) is a major contributor to heart failure. You should avoid excess cholesterol and fat (especially trans fat), and instead base your diet mostly on whole, unprocessed foods.⁷

Keys to a Heart-Healthy Diet

• Eat plenty of fruits and vegetables.

• Choose whole grains rather than refined ones.

• Limit red meat, and instead get your protein from fish, lean poultry, and legumes.

• Avoid added sugars.

• Choose low-fat or nonfat dairy products.

• Get healthy fats from sources like nuts, avocados, and olive oil.

Watching Weight

Maintaining a healthy weight helps protect your heart from the burden of having to pump blood to support a heavier body—a concern, as a strain on the heart is already a problem in heart failure. To lose weight successfully, you may need advice from a dietitian, who can evaluate your diet to see if you should cut back on carbohydrates, fat, or calories in general. 

For some people, weight loss surgery is an option when diet and exercise aren't enough to lose weight. Bariatric surgery has been shown to help prevent and manage heart failure.⁸

Physical Activity

Staying active is important for everybody, but for people with heart failure especially, it can keep your heart muscle strong. Over time, it can help make the heart work more efficiently, reducing heart rate and blood pressure. It can also boost your stamina and improve your breathing.

Exercise may not be easy for everyone with heart failure, so you should be careful to avoid overexertion. Walking is an ideal activity for most people. Remember to slow down or take a break if you ever feel too short of breath, or if you feel dizzy or faint.

Always talk with your healthcare provider before starting a new exercise routine. They can tell you which activities and intensity level are safe for you. They might even suggest a cardiac rehab program.

Over-the-Counter Therapies

Over-the-counter (OTC) medications are not normally beneficial in heart failure. In fact, a number of them can cause heart failure to worsen.⁹ Some can also interfere with prescription heart failure medications, preventing them from working as they should.

If you have heart failure, it is best not to use OTC drugs, even for routine health problems, without checking with your healthcare provider or pharmacist first. 

Some of the most common OTC medications you should avoid if you have heart failure include:¹

• Non-steroidal anti-inflammatories (NSAIDs): Drugs such as aspirin, Advil or Motrin (ibuprofen), and Aleve or Naprosyn (naproxen) can cause an increase in your blood pressure. 

• Cough medications containing pseudoephedrine (Sudafed, Actifed, Contrex, and Nyquil) may also increase your blood pressure. 

A few OTC medications that are considered safe to take if you have heart failure include:

• Chlortrimeton or Aller-Chlor (chlorpheniramine), an antihistamine used for allergies and colds

• Claritin (loratadine), a non-drowsy allergy medicine

• Robitussin DM (guaifenesin with dextromethorphan), a cough medication

• Tylenol (acetaminophen), a pain reliever

But again, it's always best to check with your healthcare provider before starting a new medication if you have heart failure.

Complementary and Alternative Medicine (CAM)

Some complementary therapies have been proven helpful in managing heart failure. These approaches do not cure or improve the condition, and they have not been proven to prolong life. However, they may improve symptoms and help prevent heart failure from worsening. 

• Mind-body interventions: Techniques such as yoga, tai-chi, acupuncture, biofeedback, and reflexology are generally done with the guidance and supervision of a trained expert. Studies have shown that these interventions can provide small to moderate benefits for people with heart failure.¹⁰

• Stress reduction: Stress management techniques such as meditation, counseling, mindfulness, and lifestyle adjustment have produced moderate benefits in heart failure. There are various stress management techniques, and selecting the approach that best fits your personality is important.

• Curcumin: A natural spice derived from turmeric, curcumin has shown some preliminary promise in heart failure in animals. Its effectiveness in preventing or treating heart failure in humans is unknown.¹¹

Complementary therapies should never be used in place of medical treatments recommended by your healthcare provider. Always tell your practitioner about any alternative or complementary treatments you're using.

Procedures

Surgery or other procedures do not cure heart failure itself. They can, however, improve heart function, regulate an irregular heart rhythm, or repair a heart valve abnormality, which may be appropriate and beneficial in some—though not all—people with this condition.

Defibrillator

An implantable defibrillator is a pacemaker-like device that is used to prevent sudden death in people who are at high risk for this event. If a dangerous arrhythmia occurs, the implantable defibrillator can automatically deliver a shock to the heart to restore the rhythm back to normal.

Cardiac Resynchronization Therapy (CRT)

A CRT device is a specialized pacemaker that can coordinate the pumping action of the heart's right and left ventricles, to improve the efficiency of the heartbeat. CRT can be useful in selected people with heart failure who also have certain kinds of bundle branch block.

Implantation of a defibrillator or CRT device may take place in the operating room or in a specialized cardiac suite in the hospital. They are usually done under local anesthesia and are typically tolerated well. Most people stay in the hospital for observation for about 24 hours. 

Left Ventricular Assistive Device (LVAD)

LVADs are battery-operated pumps implanted in the body to assist the heart with pumping. They were initially considered a way to support the heart function for people who were waiting for heart transplants, but they are effective and can be used as a more long-term plan.

Placement of these devices requires general anesthesia and a recovery period of several days. You should also expect your medical team to test the effectiveness of the device shortly after the procedure and periodically for the long term.

Heart Transplant

A heart transplant is a procedure in which your heart is surgically removed and completely replaced with a donor's heart. This is a major surgical procedure, requiring general anesthesia and intense monitoring during surgery. You should expect close monitoring after surgery, several weeks of recovery, as well as a plan for cardiac rehabilitation after your transplant. 

Catheter Ablation

A catheter ablation is a procedure that blocks the erratic electrical activity that causes heart rhythm abnormalities by destroying or interrupting the area responsible for the problems.¹² You might benefit from this procedure if you have an irregular heart rhythm. 

You may have the procedure in the operating room or in a specialized cardiac procedural suite in the hospital. You can expect a relatively quick recovery if your procedure is uncomplicated. 

Valve replacement

A replacement heart valve can address blood flow restriction due to abnormal valve structure. This may be a routine procedure, or it may be quite extensive, depending on the severity of the valve problem and how many valves are affected.

A heart valve replacement uses either an artificial valve or one composed of human or pig tissue. Which type of heart valve replacement is best for you depends on your anatomical heart valve problem and your personal preferences.

Summary

Although there is no cure for heart disease, survival and quality of life can be improved with medical treatment, lifestyle modification, and specialized surgical procedures.

Prescription medications, such as beta-blockers, ARNIs, and diuretics, are the most used approaches to heart failure treatment. These drugs work by stimulating the heart to pump more efficiently, preventing excess fluid from building up in the body, or lowering blood pressure.

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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.