Treatment of Heart Failure

Treatment of heart failure focuses on stabilizing the patient, improving the symptoms, and treating the underlying cause. Treatment includes lifestyle changes, drug therapy, and occasional use of implantable devices.

Lifestyle changes

First of all, the dietary habits of the person should be changed.

• People with congestive heart failure should reduce the daily salt intake since it can increase the retention of liquid in the body.
• If the person is suffering from obesity, the daily caloric intake should be reduced to a number 30% below the recommended number of calories calculated using the patient’s weight. It is important not to reduce the caloric intake by too much, since this will prevent the person from losing weight as the body goes into “starvation mode”.
• Fluid intake and excretion should be carefully monitored as this can provide a warning sign if the patient’s condition is getting worse.

Following a program of exercises designed specifically for the patient is also very important for the wellbeing of the patient. 

Drug therapy

Drug therapy of congestive heart failure includes the following groups of drugs:

• Angiotensin-converting enzyme (ACE) inhibitors. ACE inhibitors reduce the blood pressure by lowering the peripheral resistance of the arteries. In numerous studies, ACE inhibitors were proven to reduce mortality of the patients with left-sided heart failure.
• Beta-blockers – these drugs slow down the heart beat and increase the force with which the heart can contract. This allows increasing the blood flow and combating some of the symptoms associated with left ventricular dysfunction.
• Loop diuretics – can either be used to lower blood pressure in case of an emergency, or to excrete the excess fluids from the body.
• Parenteral iron -  About one third of patients with heart failure also develop an iron-deficient anemia. Treating the anemia significantly improves the patient’s quality of life and even reduces the classification of severity of heart failure. 

Surgical therapy

Patients with severe cardiomyopathy that resulted in left ventricular ejection fraction to be below 35%, are advised to have a cardioverter defibrillator implanted. This can reduce the risk of possible fatal arrhythmias. Moreover, patients with evidence of abnormal conduction within the heart can benefit from ventricular resynchronization.

In rare cases, cardiac transplantation is advised. However, after this procedure, the patient must use immunosuppressant drugs for the rest of his or her life, which can result in many possible complications.

In the past, ventricular assist devices were used temporarily as the patient waited for the heart transplant. However, modern ventricular assist devices can be used instead of heart transplantation to prolong the patient’s life even if the patient isn’t going to have cardiac transplantation.

Prognosis

Prognosis for patients with congestive heart failure can be made either by using clinical prediction rules or by using cardiopulmonary exercise (CPX) testing.

CPX testing is a very important method for making a prognosis for patients with advanced heart failure. This test is mandatory for patients who may undergo a heart transplantation in order to assess the prognosis. CPX testing measures the exhaled carbon dioxide and oxygen during exercise. The peak oxygen consumption (VO2 max) is the main factor for making a prognosis. Generally, VO2 max of <12-14 cc/kg/min corresponds with poor survival and, thus, is advised to undergo a heart transplantation.