# Treatment Methods for Chronic Heart Failure
In chronic heart failure, treatment is tailored to the type of heart failure (reduced or preserved pump function), the stage, and the underlying cause. The goals are symptom relief, preventing further deterioration, and where possible improving pump function and pump efficiency. Below are the standard treatments outlined by group.
Medications that improve pump function
ACE inhibitors and angiotensin II receptor antagonists (ARBs)
ProveniIncluded in official guidelines, or approved by EMA or FDA
These medications work by counteracting the narrowing of blood vessels, so the heart doesn't have to pump as hard. They block a substance in the body (angiotensin II) that narrows blood vessels and thickens heart tissue. This reduces the strain on the heart.
Known side effects include coughing (especially with ACE inhibitors), dizziness from low blood pressure, and elevated potassium levels in the blood. These effects are monitored regularly with blood tests.
Beta blockers
ProveniIncluded in official guidelines, or approved by EMA or FDA
These medications slow the heart rate and reduce the force of heart contractions, allowing the heart to work more calmly. They are particularly effective in heart failure with reduced pump function.
Possible side effects include fatigue, slow heart rate, dry mouth, and rarely worsening of symptoms if the dose is increased too quickly. Many patients experience better tolerance over time.
Aldosterone Antagonists
ProveniIncluded in official guidelines, or approved by EMA or FDA
These medications block aldosterone, a hormone that promotes fluid retention and can damage heart tissue. They are mainly used for moderate to severe symptoms.
Possible side effects include elevated potassium levels, breast gland enlargement in men, and hormonal effects. Regular monitoring of potassium and kidney function is important.
SGLT2 Inhibitors
ProveniIncluded in official guidelines, or approved by EMA or FDA
These medications block sugar excretion in the kidneys. Although they were developed for diabetes, they work favorably in heart failure – possibly because they reduce fluid excess and protect heart tissue. This group is increasingly used in non-diabetic patients as well.
Possible side effects include genital infections, dizziness, and rarely serious kidney problems. Regular kidney checks are part of the monitoring.
Angiotensin-Neprilysin Inhibitors (ARNI)
ProveniIncluded in official guidelines, or approved by EMA or FDA
These combination medications work in two ways: they block angiotensin II (see ARBs) and at the same time enhance the action of a substance (natriuretic peptide) that promotes fluid excretion and vessel dilation. They are considered a replacement for ACE inhibitors or ARBs.
Possible side effects include low blood pressure with dizziness, coughing, and elevated potassium. As with all blood pressure-lowering medications, kidney function and potassium can fluctuate.
Medications for fluid retention
Diuretics
ProveniIncluded in official guidelines, or approved by EMA or FDA
These water pills increase the excretion of water and salt through the kidneys, reducing the amount of fluid the body retains. This relieves fluid buildup in the lungs and tissues.
Possible side effects include low blood pressure, low potassium and sodium levels, and dehydration. Dosing is adjusted based on fluid load and symptoms.
Medications for heart rhythm and rate
Digitalis glycosides
ProveniIncluded in official guidelines, or approved by EMA or FDA
This old substance strengthens heart contractions and slows heart rate. It is mainly used in atrial fibrillation (irregular heartbeat) occurring together with heart failure.
Possible side effects include nausea, dizziness, and heart rhythm disturbances at excessively high levels. Regular blood tests monitor the concentration.
Non-medication treatments
Cardiac Resynchronization Therapy (CRT)
ProveniIncluded in official guidelines, or approved by EMA or FDA
In heart failure with dyssynchrony (uncoordinated contraction of the heart chambers), a special pacemaker (CRT device) may be implanted. This device sends electrical pulses to both chambers so they contract in better synchronization, increasing pump efficiency.
Possible side effects include infections at the implant site, damage to blood vessels, and rarely pneumothorax (collapsed lung). Most patients tolerate the device well.
Implantable defibrillator (ICD)
ProveniIncluded in official guidelines, or approved by EMA or FDA
This device is inserted when serious heart rhythm disorders (ventricular fibrillation) are at risk. It recognizes life-threatening rhythms and delivers an electrical shock to restore normal rhythm.
Possible side effects include infections, bleeding, and psychological strain from unexpected shocks. Regular monitoring of the device is necessary.
Mechanical support of the heart
ProveniIncluded in official guidelines, or approved by EMA or FDA
In very severe heart failure, artificial hearts or left ventricular assist devices (LVAD) can be implanted. These pumps blood around, allowing the damaged heart to rest. This can be a bridge to transplantation or a permanent solution.
Possible side effects include infections, blood clots, and mechanical defects. These are procedures with significant risks, but also major life-extending benefits for selected patients.
Heart transplantation
ProveniIncluded in official guidelines, or approved by EMA or FDA
For very severe heart failure where no other medication or device offers a solution, transplantation is an option. A healthy heart from a donor is implanted.
Possible side effects include rejection reactions (the body refuses the foreign heart), infections from immune suppression, and side effects of immunosuppressive medications. This procedure requires lifelong follow-up and medication.
Lifestyle and supportive measures
Rehabilitation and physical activity
ProveniIncluded in official guidelines, or approved by EMA or FDA
Guided cardiac rehabilitation with dosing adjusted to exercise capacity helps patients improve their capacity, reduce anxiety, and manage symptoms better. Regular exercise under guidance promotes endurance.
Possible side effects include shortness of breath or chest pain with overexertion – which is why guidance by professionals is important.
Salt restriction and fluid management
ProveniIncluded in official guidelines, or approved by EMA or FDA
Lower salt intake reduces water retention. In severe failure, fluid excretion restriction may also be necessary.
Effects are noticeable in fluid balance and symptoms; no direct side effects, but strict adherence requires discipline.
Psychological support and patient education
ProveniIncluded in official guidelines, or approved by EMA or FDA
Guidance by social work, psychologists or patient groups helps patients cope with chronic illness, anxiety and depression. Also understanding what your body does (psychoeducation) contributes to treatment adherence.
No side effects; support is part of holistic care.
Medications under investigation
GLP-1 receptor agonists
ResearchediPositive results in clinical studies, not yet standard treatment
These medications, initially for diabetes, show benefits for heart failure in studies, especially through weight reduction and possible direct heart protection. Multiple large trials are still ongoing.
Possible side effects include nausea, vomiting, and rarely serious pancreatitis. Studies are continuing in heart failure populations.
Vicadrostat (BI 690517) in combination with SGLT2 inhibitors
ExperimentaliOngoing in study setting, outcome still unknown
This is a new drug being studied in combination with empagliflozin for heart failure with reduced pump function. It works on a different biological pathway than existing drugs.
This is ongoing in trial settings; side effects are still being mapped.
Treatment of underlying causes
When heart failure stems from other diseases (high blood pressure, atrial fibrillation, heart valve abnormalities, amyloidosis), treatment also focuses on those causes. This can include medication use, catheterization, or surgery.
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_This information never replaces a doctor's judgment. Always discuss your situation with your own healthcare provider._