From the Guidelines
Left-sided heart failure should be managed with a combination of medications including ACE inhibitors, beta-blockers, diuretics, and SGLT2 inhibitors, as well as lifestyle modifications, to improve morbidity, mortality, and quality of life. The treatment of left-sided heart failure typically involves a combination of medications, including ACE inhibitors (like lisinopril 10-40mg daily), beta-blockers (such as metoprolol 25-200mg daily), diuretics (furosemide 20-80mg daily), and aldosterone antagonists (spironolactone 25-50mg daily) 1. However, the most recent guidelines suggest that SGLT2 inhibitors, such as empagliflozin 10mg daily, should also be considered for patients with heart failure, regardless of left ventricular ejection fraction, due to their mortality benefits 1.
Key aspects of treatment include:
- Medications: ACE inhibitors, beta-blockers, diuretics, aldosterone antagonists, and SGLT2 inhibitors
- Lifestyle modifications: sodium restriction (<2g daily), fluid restriction (1.5-2L daily), regular moderate exercise, and smoking cessation
- Monitoring: daily weights, reporting weight gains >2kg in 3 days, and tracking symptoms like increased shortness of breath or swelling
Left-sided heart failure leads to pulmonary congestion because blood backs up into the lungs when the left ventricle fails to eject blood properly, causing symptoms like shortness of breath, orthopnea, and paroxysmal nocturnal dyspnea. Regular follow-up with healthcare providers is essential to adjust medications and monitor disease progression 1.
From the FDA Drug Label
Sacubitril and valsartan tablet is indicated: • to reduce the risk of cardiovascular death and hospitalization for heart failure in adult patients with chronic heart failure Benefits are most clearly evident in patients with left ventricular ejection fraction (LVEF) below normal.
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. Benefits are most clearly evident in patients with left ventricular ejection fraction (LVEF) below normal.
Left sided heart failure is a type of heart failure that affects the left side of the heart. The FDA drug label for sacubitril-valsartan indicates that this medication is used to reduce the risk of cardiovascular death and hospitalization for heart failure in adult patients with chronic heart failure, with benefits most clearly evident in patients with left ventricular ejection fraction (LVEF) below normal 2, 2, 2. This suggests that sacubitril-valsartan can be used to treat left sided heart failure, particularly in patients with reduced LVEF.
- Key points:
- Sacubitril-valsartan is indicated for adult patients with chronic heart failure
- Benefits are most clearly evident in patients with LVEF below normal
- Can be used to treat left sided heart failure, particularly in patients with reduced LVEF
From the Research
Left Sided Heart Failure
- Left sided heart failure, also known as left ventricular failure, occurs when the left side of the heart is not pumping blood efficiently 3.
- This can lead to a range of symptoms, including shortness of breath, fatigue, and swelling in the legs and feet.
Treatment Options
- Angiotensin-converting enzyme (ACE) inhibitors are a common treatment for left sided heart failure, as they have been shown to reduce mortality and hospitalization in patients with heart failure 4, 5, 6.
- Angiotensin receptor blockers (ARBs) are also used to treat left sided heart failure, and have been shown to be effective in reducing mortality and hospitalization in patients with heart failure 3, 5.
- Angiotensin receptor-neprilysin inhibitors (ARNIs) are a newer class of medication that have been shown to be effective in reducing mortality and hospitalization in patients with heart failure 7.
Benefits and Risks
- The use of ACE inhibitors and ARBs in patients with left sided heart failure has been shown to reduce mortality and hospitalization, and improve quality of life 4, 5, 6.
- However, these medications can also have adverse effects, such as cough, skin rash, and hyperkalemia 3, 4.
- ARNIs have been shown to be safe and well tolerated, but may also have adverse effects, such as hypotension and increased levels of angiotensin II 7.
Clinical Trials
- Several clinical trials have compared the effectiveness of ACE inhibitors and ARBs in patients with left sided heart failure, and have shown that these medications can reduce mortality and hospitalization 3, 5.
- The use of ARNIs in patients with left sided heart failure has also been studied in clinical trials, and has been shown to be effective in reducing mortality and hospitalization 7.