Treatment (1) | NICS Well

For most people, heart failure is a long-term condition that can't be cured. But treatment can help keep the symptoms under control, possibly for many years.

The main treatments are:

healthy lifestyle changes
medication
devices implanted in your chest to control your heart rhythm
surgery

In many cases, a combination of treatments will be required.

Treatment will usually need to continue for the rest of your life.

Care plan

If you have heart failure, you and everyone involved in your care will be given a care plan.

This should include:

plans for managing your heart failure, including follow-up care, rehabilitation and access to social care
symptoms to look out for in case your condition worsens
details of how to contact your care team or specialist

The care plan should be reviewed at least every 6 months by your GP.

Lifestyle changes

Having a healthy lifestyle, including eating a balanced diet, doing exercise and not smoking, can help with your symptoms and reduce your risk of becoming seriously ill.

You should be offered an exercise-based cardiac rehabilitation programme.

Find out more about living with heart failure

Medicines for heart failure

Most people with heart failure are treated with medication. Often you'll need to take 2 or 3 different medicines.

Some of the main medicines for heart failure include:

ACE inhibitors
angiotensin receptor blockers (ARBs)
beta blockers
mineralocorticoid receptor antagonists
diuretics
ivabradine
sacubitril valsartan
hydralazine with nitrate
digoxin

You may need to try a few different medicines before you find a combination that controls your symptoms but doesn't cause unpleasant side effects.

ACE inhibitors

Angiotensin-converting enzyme (ACE) inhibitors work by relaxing and opening up your blood vessels, which makes it easier for your heart to pump blood around the body.

Examples of ACE inhibitors include ramipril, captopril, enalapril, lisinopril and perindopril.

The most common side effect of ACE inhibitors is a dry, irritating cough.

If you have a troublesome cough, an ACE inhibitor may be switched to an ARB.

ACE inhibitors can also cause your blood pressure to fall too low, and they may cause kidney problems. Your GP will monitor this.

Angiotensin receptor blockers (ARBs)

Angiotensin receptor blockers (ARBs) work in a similar way to ACE inhibitors by relaxing blood vessels and reducing blood pressure.

They tend to be used as an alternative to ACE inhibitors because they don't usually cause a cough, although they may not be quite as effective as ACE inhibitors.

Examples of ARBs include candesartan, losartan, telmisartan and valsartan.

Side effects of ARBs can include low blood pressure and high levels of potassium in your blood.

Your doctor will carry out regular blood tests to monitor your potassium level.

Beta blockers

Beta blockers work by slowing your heart down and protecting your heart from the effects of adrenaline and noradrenaline, "fight or flight" chemicals produced by the body.

There are several different beta blockers, but the main ones used to treat heart failure in the UK are bisoprolol, carvedilol and nebivolol.

Possible side effects include dizziness, tiredness and blurred vision.

But most people taking them have either no or very mild side effects that become less troublesome with time.

Mineralocorticoid receptor antagonists (MRAs)

MRAs make you pass more urine, and help lower blood pressure and reduce fluid around the heart, but they don't reduce potassium levels.

The most widely used MRAs are spironolactone and eplerenone.

Spironolactone may cause enlarged breasts in men (gynaecomastia) and breast tenderness and increased hair growth in women.

Eplerenone can cause sleeping difficulties, dizziness and headaches.

The most serious side effect of these medicines is that they can cause the level of potassium in your blood to become dangerously high.

Your doctor will carry out regular blood tests to check for this.

Diuretics

Diuretics (water pills) make you pass more urine and help relieve ankle swelling and breathlessness caused by heart failure.

There are many different types of diuretic, but the most widely used for heart failure are furosemide (also called frusemide) and bumetanide.

Possible side effects of diuretics include dehydration and reduced levels of sodium and potassium in the blood.

Ivabradine

Ivabradine is a medicine that can help slow your heart down.

It's a useful alternative to beta blockers if you can't take them or they cause troublesome side effects.

It can also be used alongside beta blockers if they don't slow the heart enough.

Possible side effects include headaches, dizziness and blurred vision.

Sacubitril valsartan

Sacubitril valsartan is a single tablet that combines an ARB and a medication called a neprilysin inhibitor.

It's suitable for people with more severe heart failure, whose heart is only able to pump a reduced amount of oxygenated blood around the body despite taking other medication.

The most common side effects of sacubitril valsartan are low blood pressure, high potassium levels and kidney problems.

Hydralazine with nitrate

Hydralazine in combination with nitrate can help relax and open up the blood vessels.

These medicines are sometimes prescribed by heart specialists (cardiologists) for people who are unable to take an ACE inhibitor or ARB.

Side effects can include headaches, a fast heartbeat and a pounding, fluttering or irregular heartbeat (palpitations).

Digoxin

Digoxin can improve your symptoms by strengthening your heart muscle contractions and slowing down your heart rate.

It's normally only recommended for people who have symptoms despite treatment with ACE inhibitors, ARBs, beta blockers and diuretics.

Possible side effects include dizziness, blurred vision, feeling and being sick, diarrhoea and an irregular heartbeat.

Take your medication

It's very important that you take any prescribed medication, even if you begin to feel better.

Check with your care team if:

other medicines might interfere with your medication
you experience any side effects

Devices for heart failure

Some people with heart failure will need to have a procedure to implant a small device in their chest that can help control their heart's rhythm.

The most commonly used devices are:

pacemakers
cardiac resynchronisation therapy (CRT) devices
implantable cardioverter defibrillators (ICDs)
CRT-Ds

Pacemakers

You may need to have a pacemaker fitted if your heart beats too slowly.

A pacemaker monitors your heart rate continuously, and sends electrical pulses to your heart to keep it beating regularly and at the right speed.

The pacemaker is implanted under the skin by a cardiologist, usually under local anaesthetic.

You'll usually need to stay in hospital overnight to check it's working properly. Serious complications are unusual.

Pacemakers need to be checked regularly by specialist technicians at a pacemaker clinic.

You'll also need to be careful about things that can affect how your pacemaker works, such as hospital equipment and security systems in shops or at airports.

Cardiac resynchronisation therapy

In some people with heart failure, the walls of the main pumping chamber (the left ventricle) don't work together and contract out of sync with each other.

Cardiac resynchronisation therapy (CRT) is a special type of pacemaker that can correct the problem by making the walls of the left ventricle all contract at the same time. This makes the heart pump more efficiently.

Most pacemakers only have 1 or 2 wires to the heart, but CRT requires an extra wire that's a bit harder to get into place than the other wires.

Implantable cardioverter defibrillators (ICDs)

People who have, or are at high risk of developing, an abnormal heart rhythm may need to have a device known as an implantable cardioverter defibrillator (ICD) fitted.

An ICD constantly monitors the heart rhythm.

If the heart starts beating dangerously fast, the ICD will try to bring it back to normal by giving it a small, controlled electrical shock (defibrillation).

If this fails, the ICD will deliver a larger shock.

As with pacemakers, ICDs are implanted in hospital, usually under local anaesthetic.

Like pacemakers, you'll need to avoid things that can interfere with the way the ICD works, such as airport security systems.

Read more about ICDs on the British Heart Foundation website.

CRT-Ds

Devices that combine cardiac resynchronisation and defibrillation are implanted into patients who need both.

These combination devices are usually called CRT-Ds.

Surgery

Medicines are the main treatment for heart failure, but for some people surgery may help.

Operations that can help with heart failure include:

heart valve surgery
a coronary angioplasty or bypass
left ventricular assist devices
heart transplant

Heart valve surgery

If the valves of your heart are damaged or diseased, your doctor may suggest valve surgery.

There are 2 types of valve surgery: valve replacement and valve repair.

The type of surgery you have will depend on what's wrong with the valve and how serious the problem is.

Your doctor will discuss this with you.

Read about aortic valve replacement and surgery for mitral valve problems.

Angioplasty or bypass

If your heart failure is related to coronary heart disease, your doctor may recommend a:

coronary angioplasty – where a tiny balloon is used to stretch open a narrowed or blocked artery
coronary artery bypass graft (CABG) – where a blood vessel from another part of the body is used to divert blood around narrowed or clogged parts of an artery

These procedures will help make it easier for your heart to pump blood around your body.

Left ventricular assist devices

Left ventricular assist devices (LVADs) are mechanical pumps that can help if your left ventricle isn't working properly and medication alone isn't helping.

They may be used as a permanent treatment if you can't have a heart transplant, or as a temporary measure while you wait for a transplant.

In addition to the pump, LVADs also include an external battery. A wire connecting this to the pump will need to be placed under your skin during the operation.

Read more about LVADs on the British Heart Foundation website.

Heart transplant

A heart transplant may be necessary if you develop severe heart failure that can't be treated effectively with medication or other types of surgery.

A heart transplant is a complex procedure that carries serious risks, so it's not suitable for everyone with severe heart failure.

There's also a shortage of hearts for transplantation, so some people have to wait years for a suitable donor heart to become available.

Treatment