Heart Failure

With treatment, the symptoms of congestive heart failure can improve. It is a chronic condition, meaning that you will need to take care of it for the rest of your life. Sometimes even small changes in your diet and activity level can help you feel better.

Depending on the severity of heart failure, congestive heart failure treatment may include medication, exercise, implanted devices, surgery, or a heart transplant.

Medications for heart failure

Heart failure medications are designed to reduce high blood pressure, heart rate, fluid build-up and improve blood flow. You may need to take several medicines to treat heart failure, even if you don’t have symptoms yet.

It’s essential to take your medicine exactly as your doctor says. Talk to your doctor before taking any over-the-counter drugs — they could worsen your symptoms.

The most common medications for heart failure include:

• ACE inhibitors (angiotensin-converting enzyme inhibitors) relax and widen blood vessels. This makes it easier for blood to flow. Examples include enalapril (Vasotec, Epaned), lisinopril (Zestril, Qbrelis, Prinivil), and captopril.
• Aldosterone receptor antagonists, a type of diuretic, make the kidneys rid themselves of extra fluid. Examples include spironolactone (Aldactone, Carospir), eplerenone (Inspra).
• ARBs (angiotensin II receptor blockers) make it easier for blood to flow through the blood vessels. Examples include losartan (Cozaar), valsartan (Diovan), candesartan (Atacand).
• ARNI (angiotensin receptor neprilysin inhibitor) medicine makes blood flow through the blood vessels easier. ARNI medicine may be used instead of an ACE inhibitor or an ARB.
• Beta-blockers slow the heart rate. They can also help the heart fill up completely with blood. Examples include carvedilol (Coreg), metoprolol (Lopressor, Toprol-XL, Kapspargo Sprinkle), bisoprolol.
• Digoxin helps the heart pump more blood with each beat.
• Diuretics help relieve symptoms like swelling in the legs. Examples include furosemide (Lasix).
• Hydralazine taken with a nitrate widens the blood vessels. This medicine can lower high blood pressure and reduce the workload on the heart.
• Ivabradine slows the heart rate. This medicine may help prevent some people from being hospitalized for heart failure.
• Antiarrhythmics prevent very fast and sometimes irregular heart rhythms.
• Blood thinners, also known as anticoagulants, prevent dangerous blood clots.

Exercise for heart failure

Regular exercise can improve your heart function and reduce symptoms. Speak with your doctor about the types of exercise that may be best for you.

• Cardiac rehabilitation. A medically supervised exercise program is offered at NewYork-Presbyterian. In addition to exercise, it includes nutritional counseling and additional support to improve your quality of life.
• Exercise at home. Ask your doctor for advice on aerobic exercise, strength training, and stretching that you can do at home to get stronger and become more active.

Defibrillators and pacemakers

Sometimes heart failure symptoms are not well controlled by medication or exercise. Your doctor may recommend an implanted device to manage heart rhythm problems associated with heart failure. Such devices include:

• Pacemakers. Small devices implanted under the skin in the chest used to ensure the heart beats at an appropriate rate.
• Implantable cardioverter defibrillators (ICDs). Small devices, similar to pacemakers, are implanted under the skin (most often in the chest) and used to protect against life-threatening arrhythmias and sudden cardiac death.
• Biventricular pacing. Implantable devices with wires directly pacing the left ventricle of the heart in addition to a standard pacemaker wire in the right ventricle.

Left ventricular assist devices

NewYork-Presbyterian has pioneered mechanical support for people with advanced heart failure. Left ventricular assist devices take on the workload of the left ventricle, helping your heart pump blood to the rest of your body. An LVAD has three main parts: an electric pump implanted inside your body and attached to your heart, an electronic control system worn outside your body and connected to the pump, and a power supply.

Our cardiac surgeons have one of the largest LVAD volumes nationwide, with survival rates exceeding the national average.

Heart transplantation

If you have end-stage heart failure that does not respond to other treatments, you may be a candidate for a heart transplant. Doctors in our Heart Failure and Transplantation Programs are making continuous advances in medical and immunologic therapies, surgical techniques, imaging methods, and device development.

The heart transplant team at NewYork-Presbyterian expanded the usual criteria by which donor hearts are accepted. As a result, waiting times for a heart transplant are lower here than at other centers in the region. The ability to transplant sooner translates into better outcomes for our patients.