Heart failure results from impairment of the heart's pumping action. Commonly this is related to heart muscle damage that cannot be repaired. However, many treatments available can help to keep the condition under control and help to relieve the symptoms.
In addition, many of the conditions that cause heart failure can also be treated effectively. This reduces the pressure on your heart and prevents further deterioration.
The information below highlights the medication that you may be prescribed by your GP or specialist. This will be after discussing treatment options with you and identifying the appropriate choice for your individual circumstances.
The standard medicines for treating heart failure are:
- angiotensin converting enzyme (ACE) inhibitors
- angiotensin receptor blockers (ARBs)
- beta blockers
- diuretics (water tablets)
- mineralocorticoid receptor antagonists (MRAs)
Angiotensin converting enzyme (ACE) inhibitors
ACE inhibitors relax and widen your blood vessels. This helps to improve the flow of blood around your body, which reduces the amount of work your heart has to do.
ACE inhibitors have been shown to improve the symptoms of heart failure, reduce the need for hospital admission and improve life expectancy caused by heart failure.
Your symptoms should improve within a few weeks of starting treatment.
The main side effects of ACE inhibitors are dizziness (caused by your blood pressure being too low) and a cough. You will need to have regular blood tests, at least once every year, while taking an ACE inhibitor.
If you are taking an ACE inhibitor, you should check with your doctor or pharmacist before taking any other medicines. In particular, nonsteroidal anti-inflammatory medicines (such as ibuprofen) should not be taken with an ACE inhibitor. You should also avoid products containing high levels of potassium, such as salt substitutes.
Types of ACE inhibitors
Captopril, enalapril, lisinopril and ramipril
Angiotensin receptor blockers (ARBs)
ARBs work in a similar way to ACE inhibitors.
Unlike ACE inhibitors, ARBs do not cause a cough. For this reason, they are often prescribed for people who cannot tolerate an ACE inhibitor due to cough.
Types of ARBs
Candesartan and valsartan
If your heart isn’t working properly, your body produces hormones to try and make it work better by making your heart pump faster and raising your blood pressure. However, if this continues, it can have harmful effects on your heart.
Beta-blockers block the action of these hormones. This slows your heart down and reduces your blood pressure, meaning that the heart has less work to do.
Beta-blockers have been shown to reduce the symptoms of heart failure, reduce the need for hospital admission and improve life expectancy caused by heart failure.
People with moderate or severe heart failure usually need to start with a low dose of beta-blocker, which will be slowly increased. This is because some people experience a temporary increase in their heart failure symptoms during the first few weeks of treatment.
If you feel that your symptoms are getting worse, do not stop your beta blocker. Seek medical advice.
Types of beta blockers
Bisoprolol, carvedilol and nebivolol
Diuretics (water tablets)
When you have heart failure, your heart cannot pump blood around your body as well as it should, so fluid builds up in your body. This fluid can collect in your lungs, making you breathless, or in your legs and ankles, making them swell (oedema). Diuretics increase the amount of water and salt that is removed from your body as urine. As more fluid passes out, there is less fluid left in your blood, so the excess water in your lungs and legs is drawn back into your blood, relieving your symptoms of breathlessness and oedema.
Diuretics are usually taken in the morning. The effect of making you pass more water starts about half an hour after taking them, and you may find you need to go to the toilet several times over the next few hours. Their effect wears off after about 6 hours, so you should not need to get up at night to go to the toilet.
The accumulation of fluid in your body can be measured as a gain in weight, and the loss of fluid (caused by the diuretic) can be measured as weight loss. Therefore by weighing yourself every day you can pick up any sudden increase in weight.
A sudden increase in weight means that your heart failure is not well controlled and you should seek help urgently from your doctor or heart failure nurse.
Types of diuretics
Bumetanide and furosemide
Mineralocorticoid receptor antagonists (MRAs)
MRAs work by blocking the action of a chemical called aldosterone in the body. Aldosterone causes salt and fluid to build up, so MRAs help to prevent this, reducing the symptoms of heart failure, reducing the need for hospital admission and improving life expectancy caused by heart failure.
The main side effect of MRAs is dizziness (caused by your blood pressure being too low). You will need regular blood tests, at least twice a year, to measure a salt called potassium which can become too high in some people.
If you are taking an MRA, you should check with your doctor or pharmacist before taking any other medicines. In particular, nonsteroidal anti-inflammatory medicines (such as ibuprofen) should not be taken with an MRA. You should also avoid products containing high levels of potassium, such as salt substitutes.
If you experience diarrhoea and/or vomiting, stop the MRA and contact your doctor.
Types of MRAs
Spironolactone and eplerenone
Medicines that might be used by a specialist include:
- angiotensin/neprilysin inhibitors
This is a new type of drug to treat heart failure. It is a combination of valsartan (an ARB) and a medicine called sacubitril. It may be used for people with more severe heart failure, or people with ongoing symptoms despite the standard treatments described above. It has been shown to reduce the symptoms of heart failure, reduce the need for hospital admission and improve life expectancy.
If you are already taking an ACE inhibitor or an ARB, this will need to be stopped for 36 hours before you start to take the angiotensin/neprilysin inhibitor. This is to reduce the risk of serious side effects occurring.
You will need regular blood tests, at least once per year, while taking this medicine.
Types of angiotensin/neprilysin inhibitors
Ivabradine reduces the number of times your heart beats each minute (your heart rate), meaning that the heart has less work to do. It has been shown to reduce the need for hospital admission in people with heart failure.
Ivabradine is not suitable for everyone with heart failure. It is only needed if you have a fast heart rate despite being treated with a beta blocker or if you cannot tolerate a beta-blocker. It is not suitable for people with a particular type of irregular heart rhythm called atrial fibrillation.
Digoxin can also reduce the heart rate and improve the symptoms of heart failure. It is most useful in people who have irregular heart rhythms.
It is important that you get the right dose of digoxin for you. You will need to have regular blood tests to check this. If you have too much digoxin you may develop nausea, headaches and blurred vision. If you experience any of these whilst you are taking digoxin, you should contact your doctor.
A heart transplant may be an option for people with severe heart failure, but it is not an option for everyone.
It is also dependant on the availability of a suitable donor heart.
People with heart failure often experience various types of emotional distress or behavioural disturbance. Problems such as depression and anxiety are especially common.
These conditions not only affect individuals’ emotional state but can also affect their symptoms of heart failure and influence the success of their medical care.
Fortunately, there are effective treatments for depression and anxiety available including psychological interventions such as cognitive behaviour therapy and antidepressant medication. Addressing these problems will make it easier to follow your heart failure treatment plan.
Your healthcare professional or GP will be able to help assess any concerns you have regarding your psychological wellbeing.
If you have heart failure, you have a higher risk of complications from flu and pneumococcal infection. To reduce this risk, you'll be offered a:
- yearly flu vaccine
- one-off pneumococcal immunisation