From the Guidelines
The treatment protocol for Congestive Heart Failure (CHF) should prioritize a combination of medications including an ACE inhibitor, a beta-blocker, and an MRA, as recommended by the 2016 ESC guidelines 1. The cornerstone of CHF treatment is medication therapy, with the goal of reducing the risk of HF hospitalization and death.
- An ACE inhibitor is recommended, in addition to a beta-blocker, for symptomatic patients with HFrEF to reduce the risk of HF hospitalization and death, as stated in the 2016 ESC guidelines 1.
- A beta-blocker is recommended, in addition to an ACE inhibitor, for patients with stable, symptomatic HFrEF to reduce the risk of HF hospitalization and death, also stated in the 2016 ESC guidelines 1.
- An MRA is recommended for patients with HFrEF, who remain symptomatic despite treatment with an ACE inhibitor and a beta-blocker, to reduce the risk of HF hospitalization and death, as per the 2016 ESC guidelines 1. Additionally, diuretics are recommended to improve symptoms and exercise capacity in patients with signs and/or symptoms of congestion, as noted in the 2016 ESC guidelines 1. Lifestyle modifications are also crucial, including restricting sodium intake and limiting fluid intake, as well as regular, moderate exercise as tolerated, to improve overall cardiovascular health. For some patients with reduced ejection fraction and specific ECG criteria, cardiac resynchronization therapy (CRT) or implantable cardioverter-defibrillators (ICD) may be considered, as these devices can improve heart function and reduce the risk of sudden cardiac death in appropriate candidates. The combination of medications and lifestyle changes works synergistically to modulate the neurohormonal systems that contribute to CHF, while monitoring helps prevent exacerbations and allows for timely interventions, ultimately aiming to improve quality of life and reduce morbidity and mortality.
From the Research
Treatment Protocol for Congestive Heart Failure (CHF)
The treatment protocol for Congestive Heart Failure (CHF) involves a combination of pharmacological and lifestyle modifications. The primary goals of treatment are to prevent and delay progression of the disease, improve survival, and alleviate symptoms.
Pharmacological Treatment
- Diuretics are the first line of treatment for patients with fluid retention and are necessary to relieve symptoms 2, 3, 4, 5.
- Angiotensin-converting enzyme (ACE) inhibitors are recommended for patients with left ventricular dysfunction, as they have been shown to decrease mortality and progression of CHF 2, 3, 4, 5, 6.
- Digoxin is used to improve clinical symptoms, especially in patients with atrial fibrillation 2, 3, 4, 5, 6.
- Beta-blockers are recommended for patients with stable CHF, as they have been shown to prolong survival and decrease worsening CHF 2, 3, 5, 6.
- Aldosterone antagonists may be recommended in select patients with stable New York Heart Association class III or IV heart failure 6.
- Hydralazine and isosorbide dinitrate may be used as an alternative to ACE inhibitors in patients who cannot tolerate them 2, 3, 6.
Lifestyle Modifications
- Physical activity is recommended to improve peripheral perfusion and reduce fatigue 4.
- Vasodilator therapy is recommended to improve peripheral perfusion and reduce dyspnea 4.
Special Considerations
- Antiarrhythmic agents should not be given to patients with CHF free from arrhythmia, but amiodarone may be safe for patients with sustained ventricular tachycardia or ventricular fibrillation 2, 3.
- Anticoagulation therapy is not recommended for patients with CHF in normal sinus rhythm, but may be beneficial for patients with atrial fibrillation 3, 6.