From the Guidelines
Medications specifically used for heart failure include angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), angiotensin receptor-neprilysin inhibitors (ARNIs), beta-blockers, mineralocorticoid receptor antagonists (MRAs), sodium-glucose cotransporter 2 inhibitors (SGLT2i), and diuretics. The most recent and highest quality study, 1, provides a comprehensive list of medications used for heart failure, including their initial and target doses. Key medications for heart failure management are:
- ACE inhibitors like enalapril and lisinopril
- ARBs such as losartan and valsartan
- ARNIs like sacubitril/valsartan
- Beta-blockers including carvedilol, metoprolol succinate, and bisoprolol
- MRAs such as spironolactone and eplerenone
- SGLT2 inhibitors like empagliflozin and dapagliflozin
- Diuretics for symptom management, such as furosemide and bumetanide These medications aim to reduce cardiac workload, prevent harmful cardiac remodeling, decrease fluid retention, and improve cardiac output, with the specific combination depending on the type of heart failure, severity of symptoms, and individual patient factors including kidney function and blood pressure, as supported by 1, 1, 1, and 1. Treatment typically begins with lower doses that are gradually increased as tolerated, with the goal of improving clinical status, functional capacity, quality of life, preventing hospital admission, and reducing mortality. It is essential to consider the most recent guidelines and studies, such as 1, when making treatment decisions for heart failure patients.
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. Sacubitril and valsartan tablet is indicated for the treatment of symptomatic heart failure with systemic left ventricular systolic dysfunction in pediatric patients aged one year and older.
The medication specifically used for heart failure is sacubitril-valsartan. It is indicated for the treatment of heart failure in both adult and pediatric patients. The recommended dosage varies depending on the patient's age and weight, as outlined in the dosage and administration section of the label 2.
- Key indications:
- Reduce the risk of cardiovascular death and hospitalization for heart failure in adult patients with chronic heart failure
- Treatment of symptomatic heart failure with systemic left ventricular systolic dysfunction in pediatric patients aged one year and older
From the Research
Medications for Heart Failure
The following medications are used to treat heart failure with reduced ejection fraction (HFrEF):
- Diuretics: used to relieve symptoms and are the first-line drugs in the treatment of patients with HFrEF and volume overload 3
- Angiotensin-converting enzyme (ACE) inhibitors: used in treatment of HFrEF, and can be replaced with angiotensin II receptor blockers (ARBs) if intolerant 3, 4, 5
- β-blockers: used in treatment of HFrEF, and should be used in combination with ACE inhibitors or ARBs 3, 4, 5, 6
- Angiotensin receptor-neprilysin inhibitors (ARNIs): can be used instead of ACE inhibitors or ARBs in patients with chronic symptomatic HFrEF class II or III to further reduce morbidity and mortality 3, 4, 6
- Mineralocorticoid receptor antagonists (MRAs): can be added to patients with class II-IV HF who can be carefully monitored for renal function and potassium concentration 3, 4, 5, 6, 7
- Sodium-glucose cotransporter 2 (SGLT2) inhibitors: can be used to reduce cardiovascular and all-cause mortality in patients with HFrEF, regardless of diabetes status 4, 6, 7
- Ivabradine: can be used in selected patients with HFrEF, particularly those with a heart rate above 70 beats per minute despite fully dosed β-blockers 3, 5, 6, 7
- Hydralazine and isosorbide dinitrate: can be used in patients with HFrEF, particularly African American patients with class II-IV HF who are being treated with diuretics, ACE inhibitors, and β-blockers 3, 4, 7
- Vericiguat: can be used to reduce heart failure hospitalization in high-risk patients with HFrEF 4, 6, 7
Device Therapies
In addition to medications, device therapies such as:
- Cardiac resynchronization therapy: can be beneficial in patients with interventricular dyssynchrony 4, 7
- Transcatheter mitral valve repair: can be beneficial in patients with severe secondary mitral regurgitation 4, 7
- Implantable cardiac defibrillators: can be beneficial in patients with more severe left ventricular dysfunction, particularly those with an ischemic etiology 4, 7