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Heart failure can be managed through lifestyle changes and medication. All the information, in the article.
Heart failure (HF) is a condition in which the heart does not pump enough blood to meet the body’s needs. It can feel as if the heart is like an engine that “can’t keep up.” The syndrome is accompanied by fluid retention, which manifests as shortness of breath and swelling (edema).
People with heart failure experience reduced quality of life, have difficulty performing activities that require physical effort, suffer from recurrent hospitalizations, and have a reduced life expectancy.
The causes of heart failure can be divided into two main groups, diagnosed by an echocardiogram:
In this group, the echocardiogram shows a reduced left ventricular ejection fraction (below 50%). The most common cause is a myocardial infarction and secondary damage to the heart muscle.
In these cases, there is a structural change that interferes with the filling of the heart, while the left ventricular ejection fraction is normal (above 50%).
Causes include diabetes, hypertension, and age-related changes.
Symptoms vary and include fatigue, weakness, and reduced ability to perform physical exertion.
In addition, fluid may accumulate in different organs, such as the lungs (leading to shortness of breath), the abdomen (abdominal swelling due to ascites), and the limbs (bilateral edema).
Warning signs include a decline in functional capacity, worsening shortness of breath, and the appearance of swelling in the legs.
These signs indicate the development or worsening of heart failure and signal an urgent need for treatment with diuretics and sometimes hospitalization.
The rate of deterioration varies from patient to patient.
Hospitalization is a poor prognostic sign and requires intervention and close follow-up to prevent further deterioration.
Worsening may occur just days after the first symptoms of heart failure appear; in other cases, it may occur weeks or even months later.
It is important to note that even in patients with stable heart failure, deterioration and loss of balance may occur.
The most common complication is pulmonary edema. Because blood does not flow properly due to a weakened heart, it accumulates in various parts of the body, including the lungs, which can lead to pulmonary edema. Pulmonary edema may cause respiratory failure, an emergency condition that sometimes requires mechanical ventilation and can even be fatal.
Other common complications include frequent worsening of heart failure, which requires repeated hospitalizations. These frequent hospitalizations severely impair quality of life.
In addition, heart failure may be accompanied by impaired kidney function. This combination makes medication management more difficult and increases the risk of complications.
Heart failure is a chronic disease, like other chronic conditions.
The goals of treatment are to improve overall well-being and quality of life, and to prevent hospitalizations and even death.
A key principle in managing a chronic disease is that the patient plays a central role in caring for their own health.
According to publications by the American Heart Association, people living with heart failure who take responsibility for managing their disease report significant improvements not only in their physical health but also in their mental and emotional well-being.
A crucial component is cooperation with the treating medical team, including full adherence to the treatment plan, especially taking several classes of life-saving medications.
The second component is making lifestyle changes.
Several classes of medications have been shown to improve quality of life, prevent hospitalizations, and reduce mortality from the disease, thereby prolonging life.
Treatment requires taking representatives from all these medication classes, and therefore patients are typically required to take between 4 and 6 different medications to control their condition.
This class includes drugs such as enalapril (brand names: Enalapril, Enaladex), ramipril (brand name: Tritace), and captopril (brand name: Asril).
The main side effects of these medications include worsening kidney function, increased potassium levels in the blood, and low blood pressure.
These medications are used as an alternative to ACE inhibitor drugs.
This class includes medications such as losartan (brand names: Oxer, Loten, Losarta, Losardex), valsartan (brand names: Diovan, Vector, Valsartan Dexel), and candesartan (brand names: Atacand, Amias, Candor).
This class includes only one medication: sacubitril/valsartan (brand name: Entresto or Sector).
The main side effect of this medication is low blood pressure; an increase in blood potassium levels may also occur.
Many drugs belong to the beta-blocker class, but only two that are approved in Israel have been found suitable for the treatment of heart failure:
Bisoprolol (brand names: Cardiloc, Concor, Bisoprolol)
Carvedilol (brand name: Carvedexon)
Common side effects of these medications include fatigue and weakness (especially at the beginning of treatment), as well as reduced blood pressure and heart rate.
Medications in this class include spironolactone (brand names: Aldactone, Spironolactone, Spironol) and eplerenone (brand names: Inspra, Eplerenone Normon).
The main side effects of these medications are increased potassium levels in the blood and low blood pressure.
Spironolactone may, in rare cases, cause breast enlargement (gynecomastia) in men.
These medications were originally used to treat diabetes. Numerous studies have shown that they reduce hospitalizations and mortality in patients with heart failure, even in those without diabetes, and protect kidney function in patients with and without diabetes.
Medications in this class include empagliflozin (brand name: Jardiance) and dapagliflozin (brand name: Forxiga).
These medications work through several mechanisms: they increase urine excretion, reduce fluid overload and edema, lower blood pressure, and decrease the workload on the heart and kidneys. They improve heart failure symptoms, reduce recurrent hospitalizations, and improve patient survival.
Medications in this class include furosemide (brand name: Fusid) and metolazone (brand names: Diulo, Zaroxylin).
Diuretics reduce fluid accumulation and swelling in the legs and lungs.
Furosemide is usually given in tablet form, but can also be administered by injection.
Do not be alarmed by the large number of medications prescribed for the patient. These medications can be life-saving.
Combination therapy prevents complications and hospitalizations and improves the patient’s quality of life. The use of combination therapy is based on extensive, long-standing medical evidence. It is important to remember that each medication plays an important role in maintaining health, and therefore all prescribed medications must be taken as directed.
Medical follow-up is critical and is preferably carried out within a heart failure clinic.
Medications should not be stopped even when the patient’s condition improves, except on the advice of a physician.
The physician at the heart failure clinic takes a comprehensive view of the patient’s medical problems, introduces treatment gradually, and performs individualized dose adjustments.
Patients with heart failure often have a “cluster” of underlying conditions such as high blood pressure, diabetes, high cholesterol, and sometimes excess weight. Health risks increase as the number of risk factors rises. Adhering to self-care practices and prescribed medications can also help improve these conditions.
Lifestyle changes include:
Pay attention to the following signs and report them to the treating medical team if they occur:
Heart failure is a chronic condition that can be managed and whose associated complications can often be prevented. To a large extent, treatment success depends on the patient.
The condition requires understanding and adherence to a treatment regimen that includes lifestyle changes combined with multiple medications. Close medical follow-up is a key component of care, helping to prevent disease worsening and the development of complications, and thereby improving the patient’s quality of life.
At Mesilat Yesharim Clinic in Jerusalem, a dedicated heart failure clinic operates, providing medical and nursing care, guidance, counseling, follow-up, and ongoing support.
To attend the clinic, a physician referral is required, along with scheduling an appointment by phone at 02-567-7667 or through Leumit’s customer service center at *507.
