What are the medications used to treat left-sided heart failure (Left Ventricular Failure)?

From the Guidelines

Drugs used in left heart failure should include ACE inhibitors, beta-blockers, and diuretics as first-line therapy, with the addition of ARBs, aldosterone antagonists, and SGLT2 inhibitors in selected patients, as they have been shown to reduce morbidity and mortality, and improve quality of life 1.

Overview of Left Heart Failure Treatment

The treatment of left heart failure involves a combination of pharmacological and non-pharmacological interventions.

• The primary goal of treatment is to reduce symptoms, improve quality of life, and decrease morbidity and mortality.
• According to the 2011 guideline, first-line therapy with beta-blockers and ACE inhibitors is indicated for all patients with heart failure with left ventricular systolic dysfunction, regardless of the severity of their symptoms 1.
• The 2016 ESC guidelines recommend the use of diuretics to improve symptoms and exercise capacity in patients with signs and/or symptoms of congestion, and sacubitril/valsartan as a replacement for an ACE-I to further reduce the risk of HF hospitalization and death in ambulatory patients with HFrEF who remain symptomatic despite optimal treatment with an ACE-I, a beta-blocker, and an MRA 1.

Pharmacological Treatment

The pharmacological treatment of left heart failure includes:

• ACE inhibitors, such as lisinopril, which reduce afterload and mortality by blocking the renin-angiotensin system 1.
• Beta-blockers, such as metoprolol succinate or carvedilol, which improve survival by reducing sympathetic stimulation, but must be started at low doses when patients are stable 1.
• Diuretics, such as furosemide, which are first-line for symptom relief by reducing fluid overload 1.
• ARBs, such as losartan, which reduce hospitalizations for heart failure and improve quality of life, but do not have a statistically significant effect on survival 1.
• Aldosterone antagonists, such as spironolactone, which provide additional mortality benefit in moderate-to-severe heart failure 1.
• SGLT2 inhibitors, such as dapagliflozin or empagliflozin, which have shown significant mortality and hospitalization reduction benefits regardless of diabetes status 1.

Individualized Treatment

Treatment should be individualized based on heart failure severity, ejection fraction, comorbidities, and patient tolerance, with careful monitoring of renal function, electrolytes, and blood pressure throughout therapy.

• The choice of medication and dosage should be tailored to the individual patient's needs and response to treatment.
• Regular follow-up and adjustment of treatment as needed are crucial to optimize outcomes and minimize adverse effects.

From the FDA Drug Label

Sacubitril and valsartan tablets are indicated to reduce the risk of cardiovascular death and hospitalization for heart failure in adult patients with chronic heart failure and reduced ejection fraction. Sacubitril and valsartan tablets are indicated for the treatment of symptomatic heart failure with systemic left ventricular systolic dysfunction in pediatric patients aged one year and older.

The drug used in left heart failure is sacubitril and valsartan tablets.

• Indications include:
  • Reduction of risk of cardiovascular death and hospitalization for heart failure in adult patients with chronic heart failure and reduced ejection fraction.
  • Treatment of symptomatic heart failure with systemic left ventricular systolic dysfunction in pediatric patients aged one year and older. 2, 2, 2

From the Research

Drugs Used in Left Heart Failure

The following drugs are used to treat left heart failure:

• Angiotensin-converting enzyme (ACE) inhibitors 3
• Beta-blockers 3
• Angiotensin II receptor blockers (ARBs) 3, 4
• Aldosterone antagonists 3
• Isosorbide dinitrate plus hydralazine 3
• Sodium-glucose cotransporter 2 (SGLT2) inhibitors 5, 6
• Mineralocorticoid receptor antagonists (MRAs) 5, 6
• Angiotensin receptor-neprilysin inhibitors (ARNI) 5, 6

First-Line Treatment

The first-line treatment for patients with heart failure with reduced ejection fraction includes:

• Angiotensin receptor-neprilysin inhibitors
• Angiotensin-converting enzyme inhibitors
• Angiotensin receptor blockers
• β-blockers
• Mineralocorticoid receptor antagonists
• Sodium-glucose cotransporter 2 inhibitors
• Diuretics 5

Treatment Considerations

When selecting drug therapy for patients with heart failure, clinicians should consider:

• Results from clinical trials in specific patient populations 3
• Adverse-event profiles 3, 4
• Tolerability 3
• Cost 3
• Dosing regimens 3
• Comorbidities and specific clinical scenarios when dosing HF medication 7