From the Guidelines
Left-sided heart failure treatment should prioritize first-line medications including ACE inhibitors and beta-blockers to reduce morbidity and mortality, as evidenced by high-quality studies 1. The primary goal of treatment is to improve symptoms, reduce hospitalizations, and enhance quality of life. Key medications include:
- ACE inhibitors (like lisinopril 10-40 mg daily or enalapril 2.5-20 mg twice daily) to reduce blood pressure and cardiac workload
- Beta-blockers (metoprolol succinate 12.5-200 mg daily or carvedilol 3.125-25 mg twice daily) to slow heart rate and improve cardiac efficiency
- Diuretics like furosemide (20-80 mg daily) to reduce fluid retention and pulmonary congestion
- For moderate to severe cases, aldosterone antagonists (spironolactone 12.5-50 mg daily) may be added Lifestyle modifications are also crucial, including:
- Sodium restriction (<2g daily)
- Fluid restriction if needed
- Regular moderate exercise as tolerated
- Smoking cessation In advanced cases, device therapy (implantable cardioverter-defibrillators or cardiac resynchronization therapy) or heart transplantation may be considered, as recommended by separate NICE committees 1. These treatments work by reducing cardiac workload, improving contractility, preventing harmful remodeling, and managing the fluid overload that causes symptoms like shortness of breath and fatigue.
From the FDA Drug Label
Sacubitril and valsartan tablet is a combination of sacubitril, a neprilisin inhibitor, and valsartan, an angiotensin II receptor blocker, and 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. The recommended starting dosage for adults is 49 mg/51 mg orally twice daily. The target maintenance dose is 97 mg/103mg orally twice daily.
The treatment for left-sided heart failure involves the use of sacubitril-valsartan, which is indicated to reduce the risk of cardiovascular death and hospitalization for heart failure in adult patients with chronic heart failure, particularly those with left ventricular ejection fraction (LVEF) below normal. The recommended starting dosage is 49 mg/51 mg orally twice daily, with a target maintenance dose of 97 mg/103mg orally twice daily 2.
From the Research
Left-Sided Heart Failure Treatment
The treatment for left-sided heart failure involves a combination of pharmacotherapy and lifestyle modifications.
- The cornerstone of treatment uses drugs targeting the renin-angiotensin-aldosterone system (RAAS), including angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and the angiotensin receptor-neprilysin inhibitor (ARNI) sacubitril/valsartan 3.
- Sacubitril/valsartan has been shown to be beneficial in patients with heart failure with reduced ejection fraction, reducing the occurrence of cardiovascular death or hospitalization for heart failure by 20% and all-cause mortality by 16% 4, 5.
- Diuretics are important for the relief of dyspnea, but do not improve the prognosis of patients 6.
- Combination therapy with ACE inhibitors, beta blockers, and aldosterone antagonists can improve symptoms and prognosis in patients with reduced left ventricular function 6.
- For patients with heart failure with preserved ejection fraction, evidence-based measures are still lacking, and recommended therapy consists of optimal treatment of comorbidities, regulation of heart rate and blood pressure, and participation in structured exercise programs 6.
Quality of Life
Left-sided heart failure can significantly impair quality of life, with patients experiencing declines in physical functioning and mental health 7.