From the Guidelines
Heart failure medications should include a combination of ACE inhibitors or ARBs, beta-blockers, diuretics, and SGLT2 inhibitors, with the goal of improving heart function, reducing symptoms, and minimizing morbidity and mortality, as recommended by the 2022 AHA/ACC/HFSA guideline for the management of heart failure 1. The cornerstone medications for heart failure include:
- ACE inhibitors (like lisinopril, enalapril) or ARBs (losartan, valsartan) which reduce strain on the heart by dilating blood vessels
- Beta-blockers (metoprolol succinate, carvedilol, bisoprolol) that slow heart rate and reduce workload
- Diuretics (furosemide, bumetanide) that help eliminate excess fluid
- SGLT2 inhibitors (empagliflozin, dapagliflozin) that have shown mortality benefits in patients with reduced ejection fraction Additional medications that may be used in certain cases include:
- Aldosterone antagonists (spironolactone, eplerenone) for moderate to severe heart failure
- Entresto (sacubitril/valsartan) which replaces ACE inhibitors/ARBs in many patients
- Isosorbide dinitrate and hydralazine for patients with reduced ejection fraction who cannot tolerate ACE inhibitors or ARBs
- Ivabradine for patients with heart failure who have a heart rate greater than 70 beats per minute despite optimal beta-blocker therapy
- Vericiguat for patients with heart failure who have a left ventricular ejection fraction less than 45% and are on optimal medical therapy Medication titration should be gradual with regular monitoring of blood pressure, heart rate, electrolytes, and kidney function, as recommended by the 2022 AHA/ACC/HFSA guideline 1. It is essential to individualize treatment based on heart failure type (reduced vs. preserved ejection fraction), severity, and comorbidities, and to use the highest quality evidence available to guide treatment decisions, such as the 2022 AHA/ACC/HFSA guideline 1.
From the FDA Drug Label
Sacubitril and Valsartan Tablets are a prescription medicine used to treat: adults with long-lasting (chronic) heart failure to help reduce the risk of death and hospitalization. certain children 1 year of age and older who have symptomatic heart failure
The medications used to treat heart failure include sacubitril and valsartan tablets.
- 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 and reduced ejection fraction.
- Valsartan tablets have been evaluated for safety in heart failure trials, including the Valsartan Heart Failure Trial (Val-HeFT). Key points about sacubitril and valsartan tablets and valsartan tablets include:
- They are used to treat heart failure in adults and certain children.
- Sacubitril and valsartan tablets work better when the heart cannot pump a normal amount of blood to the body.
- Valsartan tablets have been shown to be effective in reducing the risk of death and hospitalization in patients with heart failure. 2 2 3
From the Research
Medications for Heart Failure
The following medications are used to treat heart failure:
- Diuretics
- β-receptor blockers
- Angiotensin-converting enzyme inhibitors (ACEI) 4, 5, 6, 7
- Angiotensin II receptor antagonists (also known as angiotensin receptor blockers) 6
- Beta-blockers 5, 8, 7
- Mineralocorticoid receptor antagonists 8
- Sodium-glucose co-transporter-2 (SGLT2) inhibitors 8
- Soluble guanylate cyclase (sGC) stimulators, such as vericiguat 8
- Ivabradine 4
- Levosimendan 4
- Omega-3 4
- Tolvaptan 4
- Recombinant human B-type natriuretic peptide (rhBNP) 4
- Isosorbide dinitrate and hydralazine (ISDN/HYD) 4
- Angiotensin-neprilysin inhibition (LCZ696) 4
Treatment Approaches
Different treatment approaches may be used, including:
- Combination therapy with ACE inhibitors and β-adrenergic receptor blockers 5
- Initiating treatment with a beta-blocker followed by an ACEI, or vice versa 7
- Using vericiguat as a potential fifth pillar for the treatment of heart failure with reduced ejection fraction, particularly in older and complex patients 8