From the Guidelines
Treatment options for Congestive Heart Failure (CHF) include pharmacological therapies, such as ACE inhibitors, beta-blockers, and diuretics, as well as surgical and mechanical interventions, like heart transplantation and left ventricular assist devices.
Pharmacological Therapies
- Diuretics are recommended to improve symptoms and exercise capacity in patients with signs and/or symptoms of congestion 1.
- ACE inhibitors or angiotensin receptor blockers (ARBs) are recommended to reduce the risk of HF hospitalization and cardiovascular death in symptomatic patients 1.
- Beta-blockers, such as bisoprolol, carvedilol, sustained-release metoprolol succinate, or nebivolol, are recommended for patients with HF with reduced ejection fraction 1.
- Mineralocorticoid receptor antagonists (MRAs) are recommended to reduce the risk of HF hospitalization and cardiovascular death in symptomatic patients 1.
- Sacubitril/valsartan is recommended 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 with an ACE-I, a beta-blocker, and an MRA 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 (or maximum tolerated dose below that), ACE-I (or ARB), and an MRA (or ARB) 1.
Surgical and Mechanical Interventions
- Heart transplantation is currently the only established surgical approach to the treatment of refractory HF, but it is available to a limited number of patients 1.
- Left ventricular assist devices (LVADs) provide similar degrees of hemodynamic support and can be used as a bridge to transplant or as destination therapy in selected non-transplant-eligible patients 1.
- Surgical or percutaneous revascularization may be considered in patients with HF who have angina or evidence of myocardial ischemia 1.
- Surgical or transcatheter aortic valve replacement may be considered in patients with HF who have severe aortic stenosis 1.
From the Research
Treatment Options for Congestive Heart Failure (CHF)
The treatment options for Congestive Heart Failure (CHF) can be categorized into several areas, including:
- Pharmacologic therapies
- Nonpharmacologic interventions
- Device-based treatments
- Surgical interventions
Pharmacologic Therapies
Pharmacologic therapies for CHF include:
- Diuretics to manage fluid overload 2, 3
- Angiotensin-converting enzyme (ACE) inhibitors to improve survival and left ventricular function 2, 3
- Beta-blockers to improve diastolic function and reduce afterload 2
- Digoxin to improve contractility 2, 3
- Vasodilators to reduce blood pressure and improve cardiac output 3
- Angiotensin receptor antagonists and neprilysin inhibitors to improve prognosis 4
Nonpharmacologic Interventions
Nonpharmacologic interventions for CHF include:
- Sodium and fluid restriction to manage fluid overload 5
- Balance of rest and physical activity to improve quality of life 5
- Hemofiltration and peritoneal dialysis for patients resistant to diuretic therapy 5
Device-Based Treatments
Device-based treatments for CHF include:
- Implantable defibrillators to improve survival 4, 6
- Biventricular pacemakers for cardiac resynchronization 4, 6
- Ventricular assist devices to improve survival 5
- Baroreflex modulation and cardiac contractility modulation, although their utility needs to be investigated further 4
Surgical Interventions
Surgical interventions for CHF include:
- Cardiac transplantation for patients refractory to conventional therapies 5
- Aortocoronary artery bypass surgery to improve cardiac function 6
- Interventions to remodel the heart and repair the mitral valve, although randomized clinical trials are lacking 6
- Catheter-based treatment of secondary mitral regurgitation with a MitraClip to improve outcome 4