Heart Failure Management

What Is Heart Failure Management

Heart failure is a condition in which the heart cannot pump or fill with blood well enough to meet the body's needs. Symptoms include shortness of breath, tiring easily, and swelling in the legs. Heart failure is usually chronic, but with the right treatment, many people with it can live longer, be hospitalized less often, and stay active. Heart failure management is a series of long-term treatments to reach that goal.

How It Works in Brief

When the heart's pumping weakens, the body activates hormones that retain salt and water and push the heart to work harder. In the short term this helps, but over time it actually worsens heart damage and causes fluid buildup. Heart failure medications block these hormones and reduce the heart's workload, diuretics remove excess fluid, and self-care prevents fluid from building up again.

Types of Heart Failure

The doctor assesses the ejection fraction, which is the percentage of blood pumped by the left ventricle with each beat, using echocardiography. This is covered on the Echocardiography page. Heart failure with reduced ejection fraction, meaning 40 percent or less, has many medication options that have been shown to help. Heart failure with mildly reduced (41 to 49 percent) and preserved (50 percent or more) ejection fraction also benefits from some medications, along with control of coexisting conditions.

Pillars of Treatment

• Four core medications: an ARNI or ACE inhibitor, a beta blocker, a mineralocorticoid receptor antagonist, and an SGLT2 inhibitor, started and then increased step by step to a beneficial dose. This is covered on the Integrated Medication Therapy page.
• Diuretics: remove excess fluid to relieve breathlessness and swelling; the dose is adjusted to your condition.
• Treating causes and coexisting conditions: such as coronary artery disease, valve disease, hypertension, arrhythmia, and iron deficiency, which often occurs alongside heart failure.
• Devices and procedures: CRT to synchronize the heartbeat, an ICD to prevent sudden death, and in advanced heart failure, a ventricular assist device (mechanical heart pump) or a transplant. These are covered on the Cardiac Resynchronization Therapy (CRT) and Implantable Cardioverter Defibrillator (ICD) pages.
• Self-care and rehabilitation: weighing yourself every day, limiting salt, staying physically active, and joining cardiac rehabilitation. This is covered on the Structured Cardiac Rehabilitation Program page.

Monitoring

The level of NT-proBNP in the blood helps assess the strain on the heart and the response to treatment. This is covered on the NT-proBNP and BNP Test page. Echocardiography is repeated to assess improvement in the heart's pumping after the medications reach their target doses.

There is no recovery period for a consultation. The key is daily self-care.

Weigh yourself every morning. Contact your doctor if your weight goes up by more than 2 kg in 3 days, as this can signal fluid buildup.

Limit salt. Cut down on salty foods, processed foods, and flavor enhancers. Limit fluids only if your doctor advises it.

Stay active. Regular physical activity and cardiac rehabilitation improve your ability to be active and reduce hospital stays.

Vaccinations and other medications. Get vaccinated against influenza and pneumonia, and avoid anti-inflammatory pain relievers without your doctor's approval.

Warning signs to watch for. Go to the emergency room right away if you experience:

• Shortness of breath at rest, or waking up at night short of breath
• Chest pain or a very fast heartbeat
• Fainting or nearly fainting
• Coughing up pink, frothy sputum