From the Guidelines
Congestive Cardiac Failure (CCF) treatment should prioritize a combination of medications including ACE inhibitors, beta-blockers, and diuretics, along with lifestyle modifications, to improve symptoms, reduce hospitalization risk, and increase survival, as recommended by the most recent guidelines 1. The symptoms of CCF include fatigue, breathlessness, and fluid buildup in the lungs and body tissues. Treatment options aim to improve these symptoms, prevent worsening of heart failure, and increase survival.
Key Treatment Components
- Medications:
- ACE inhibitors (like enalapril or lisinopril at 2.5-40mg daily)
- Beta-blockers (such as metoprolol 12.5-200mg daily or carvedilol 3.125-25mg twice daily)
- Diuretics (furosemide 20-80mg daily)
- Lifestyle modifications:
- Sodium restriction (<2g daily)
- Fluid restriction (1.5-2L daily)
- Regular moderate exercise
- Daily weight monitoring
Additional Considerations
For severe cases, additional medications like aldosterone antagonists (spironolactone 25-50mg daily) or angiotensin receptor-neprilysin inhibitors may be needed, as supported by recent guidelines 1. Regular follow-up with healthcare providers is necessary to monitor symptoms, adjust medications, and assess kidney function and electrolyte levels.
Patient Advice
Patients should be advised to report deterioration (such as tiredness, fatigue, breathlessness) and that deterioration can usually be easily managed by adjustment of other medication, as suggested by earlier guidelines 1. Patients should also be encouraged to weigh themselves daily and increase their diuretic dose if their weight increases persistently (>2 days) by >1.5–2.0 kg.
Recent Recommendations
Recent guidelines recommend 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 1. Ivabradine should be considered to reduce the risk of HF hospitalization or cardiovascular death in symptomatic patients with LVEF ≤35%, in sinus rhythm and a resting heart rate ≥70 bpm despite treatment with an evidence-based dose of beta-blocker, as indicated by recent studies 1.
From the Research
Symptoms of Congestive Cardiac Failure (CCF)
The symptoms of CCF are not explicitly stated in the provided studies, but the treatment options and management strategies discussed imply that patients with CCF often experience symptoms such as:
- Fluid overload and congestion
- Shortness of breath
- Fatigue
- Swelling in the legs and feet
- Rapid or irregular heartbeat
Treatment Options for CCF
The treatment options for CCF include:
- Pharmacologic therapy:
- Diuretics to relieve fluid overload and congestion 2, 3, 4
- Angiotensin-converting enzyme (ACE) inhibitors to reduce mortality and improve symptoms 5, 2, 3, 4, 6
- Angiotensin receptor blockers (ARBs) as an alternative to ACE inhibitors 3
- Beta-blockers to reduce mortality and improve symptoms 2, 3, 4
- Digoxin to improve symptoms and exercise tolerance 2, 3, 4
- Device therapy:
- Cardiac resynchronization therapy to reduce death and hospitalizations 5
- Combination therapy:
- Other therapies:
- Sodium-glucose cotransporter inhibitor therapy to improve mortality and hospitalization in patients with HFrEF and CKD stages 3 and 4 5
- Intravenous iron to improve symptoms in patients with heart failure and CKD stage 3 5
- Peritoneal dialysis to improve symptoms and prevent hospital admissions in patients with symptomatic fluid overload 5
Management Strategies
The management strategies for CCF include:
- Multidisciplinary approach: A combined cardiology-nephrology clinic may help improve management of patients with HFrEF and CKD 5
- Risk factor modification: Controlling diabetes and hypertension, and using antiplatelet agents and lipid-lowering agents to reduce the risk of myocardial infarction 3
- Monitoring and follow-up: Regular monitoring of patients with CCF to adjust treatment and prevent complications 2, 3, 4