How is heart failure treated?

Your treatment will depend on the type of heart failure you have and, in part, what caused it. Medications and lifestyle behaviors are part of every patient’s treatment plan. Your healthcare team will talk to you about the best treatment plan for you. Learn more about heart failure treatment.

What are the stages of heart failure?

Heart failure is a chronic long-term condition that gets worse with time. There are 4 stages of heart failure (Stage A, B, C and D). The stages range from "high risk of developing heart failure" to "advanced heart failure," and provide treatment plans. Ask your healthcare provider what stage of heart failure you are in. These stages are different from theNew York Heart Association (NYHA) clinical classifications of heart failure (Class I-II-III-IV) that reflect the severity of symptoms or functional limits due to heart failure.

As the condition gets worse, your heart muscle pumps less blood to your organs, and you move toward the next stage of heart failure. You cannot go backwards through the stages. For example, if you are in Stage B, you cannot be in Stage A again. The goal of treatment is to keep you from progressing through the stages or to slow down the progression.

Treatment at each stage of heart failure may involve changes to medications, lifestyle behaviors, and cardiac devices. You can compare your treatment plan with those listed for each stage of heart failure. The treatments listed are based on current treatment guidelines. The table outlines a basic plan of care that may apply to you. If you have any questions about any part of your treatment plan, ask a member of your healthcare team.

Stage A

Stage A is considered pre-heart failure. It means you are at high risk of developing heart failure because you have a family history of heart failure or you have one of more of these medical conditions:

  • Hypertension
  • Diabetes
  • Coronary artery disease
  • Metabolic syndrome
  • History of alcohol abuse
  • History of rheumatic fever
  • Family history of cardiomyopathy
  • History of taking drugs that can damage heart muscle, such as some cancer drugs

Stage A treatment

The usual treatment plan for patients with Stage A heart failure includes:

  • Regular exercise, being active, walking every day
  • Quitting smoking
  • Treatment for high blood pressure (medication, low-sodium diet, active lifestyle)
  • Treatment for high cholesterol
  • Not drinking alcohol or using recreational drugs
  • Medications:
    • Angiotensin converting enzyme inhibitor (ACE-I) or an angiotensin II receptor blocker (ARB) if you have coronary artery disease, diabetes, high blood pressure, or other vascular or cardiac conditions
    • Beta-blocker if you have high blood pressure

Stage B

Stage B is considered pre-heart failure. It means you have been diagnosed with systolic left ventricular dysfunction but have never had symptoms of heart failure. Most people with Stage B heart failure have an echocardiogram (echo) that shows an ejection fraction (EF) of 40% or less. This category includes people who have heart failure and reduced EF (HF­ rEF) due to any cause.

Stage B treatment

The usual treatment plan for patients with Stage B heart failure includes:

  • Treatments listed in Stage A
  • Angiotensin converting enzyme inhibitor (ACE-I) or angiotensin II receptor blocker (ARB) (if you aren't taking one as part of your Stage A treatment plan)
  • Beta -blocker if you have had a heart attack and your EF is 40% or lower (if you aren't taking one as part of your Stage A treatment plan)
  • Aldosterone antagonist if you have had a heart attack or if you have diabetes and an EF of 35% or less (to reduce the risk of your heart muscle getting bigger and pumping poorly)
  • Possible surgery or intervention as treatment for coronary artery blockage, heart attack, valve disease (you may need valve repair or replacement surgery) or congenital heart disease

Stage C

Patients with Stage C heart failure have been diagnosed with heart failure and have (currently) or had (previously) signs and symptoms of the condition.

There are many possible symptoms of heart failure. The most common are:

  • Shortness of breath
  • Feeling tired (fatigue)
  • Less able to exercise
  • Weak legs
  • Waking up to urinate
  • Swollen feet, ankles, lower legs and abdomen (edema)

Stage C treatment

The usual treatment plan for patients with Stage C HF-rEF includes:

  • Treatments listed in Stages A and B
  • Beta-blocker (if you aren't taking one) to help your heart muscle pump stronger
  • Aldosterone antagonist (if you aren't taking one) if a vasodilator medicine (ACE-I, ARB or angiotensin receptor/neprilysin inhibitor combination) and beta-blocker don't relieve your symptoms
  • Hydralazine/nitrate combination if other treatments don't stop your symptoms. Patients who are African-American should take this medication (even if they are taking other vasodilator medications) if they have moderate­ to-severe symptoms.
  • Medications that slow the heart rate if your heart rate is faster than 70 beats per minute and you still have symptoms
  • Diuretic ("water pill") may be prescribed if symptoms continue
  • Restrict sodium (salt) in your diet. Ask your doctor or nurse what your daily limit is.
  • Keep track of your weight every day. Tell your healthcare provider if you gain or lose more than 4 pounds from your "dry" weight.
  • Possible fluid restriction. Ask your doctor or nurse what your daily fluid limit is.
  • Possible cardiac resynchronization therapy (biventricular pacemaker)
  • Possible implantable cardiac defibrillator (lCD) therapy

If treatment causes your symptoms to get better or stop, you still need to continue treatment to slow the progression to Stage D.

Stage D and reduced E

Patients with Stage D HF-rEF have advanced symptoms that do not get better with treatment. This is the final stage of heart failure.

Stage D treatment

The usual treatment plan for patients with Stage D heart failure includes:

  • Treatments listed in Stages A, B and C
  • Evaluation for more advanced treatment options, including:
    • Heart transplant
    • Ventricular assist devices
    • Heart surgery
    • Continuous infusion of intravenous inotropic drugs
    • Palliative or hospice care
    • Research therapies

Stages C and D with preserved EF

Treatment for patients with Stage C and Stage D heart failure andreserved EF (HF-pEF) includes:

  • Treatments listed in Stages A and B
  • Medications for treatment of medical conditions that can cause heart failure or make the condition worse, such as atrial fibrillation, high blood pressure, diabetes, obesity, coronary artery disease, chronic lung disease, high cholesterol and kidney disease
  • Diuretic ("water pill") to reduce or relieve symptoms

YOU ARE THE MOST IMPORTANT PART OF YOUR TREATMENT PLAN!

It is up to you to take steps to improve your heart health. Take your medications as instructed, follow a low-sodium diet, stay active or become physically active, take notice of sudden changes in your weight, live a healthy lifestyle, keep your follow-up appointments, and track your symptoms. Talk to your healthcare team about questions or concerns you have about your medications, lifetyle changes or any other part of your treatment plan.

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