Treatment of Heart Failure

The principles of treatment for heart failure are to improve the symptoms of heart failure, improve the quality of life, reduce the rate of disability and hospitalization, and reduce the mortality rate. The general treatment measures for heart failure include the following: (1) General treatment: including removing or alleviating the causes of heart failure, removing heart failure triggering factors, and correcting risk factors. In the epidemic of respiratory diseases or winter and spring, vaccination against influenza and pneumonia to prevent infection. Diet should be low salt and low fat, and patients with severe heart failure should limit water intake. (2) Exercise training: Encourage patients with chronic stable heart failure to do moderate exercise, mainly to engage in daily physical activities, and the amount of exercise is appropriate to not develop heart failure symptoms. Appropriate exercise not only changes the exercise tolerance, but also changes the patient’s mental state. (3) Diuretics: For heart failure patients with fluid retention (edema), diuretics can improve cardiac function, symptoms and exercise tolerance, and reduce the rate of heart failure disability and hospitalization. Diuretics are the cornerstone of treatment in the symptomatic phase of heart failure, so diuretics should be used in all patients with heart failure with fluid retention. (4) Angiotensin-converting enzyme inhibitors (ACEI): ACEI can reduce the mortality rate, myocardial reinfarction rate, and heart failure hospitalization rate in patients with chronic heart failure, and is the cornerstone and preferred drug for heart failure treatment. ACEI must be used in all patients with chronic systolic insufficiency unless contraindicated or intolerable. It is important to emphasize that ACEI should be gradually administered from small doses to the target dose (the maximum dose tolerated by the patient’s blood pressure), and only the target dose can achieve the therapeutic purpose. (5) β-blockers: Patients with chronic stable heart failure will benefit from long-term application of β-blockers has been confirmed by many clinical trials, but they should not be used in patients with acute decompensation of chronic heart failure. It is recommended that beta-blockers must be administered to all patients with chronic systolic heart failure who are stable, have no fluid retention and are of constant weight, and do not require intravenous administration of cardiac stimulants in the near future (at least 4 days), unless contraindicated or intolerable. Note that beta-blockers should be started in small doses and slowly increased until the target dose (the maximum dose tolerated by heart rate and blood pressure) is reached. Patients should not stop or reduce the medication at will, but must use it under the guidance of a specialist. (6) Digitalis: Digitalis should be used in all patients with symptomatic heart failure. Digoxin should be used in all cases of heart failure with rapid atrial fibrillation. The combination of digoxin and beta-blockers is better than digoxin alone. (7) Angiotensin II receptor blockers (ARB): There are no clinical trials to confirm that ARB is superior or equivalent to angiotensin-converting enzyme inhibitors (ACEI), so ARB is only recommended as an alternative to ACEI in heart failure patients who cannot tolerate ACEI side effects (cough or angioedema). (8) Vasodilators: Nitrates and sodium nitroprusside exert beneficial hemodynamic effects by affecting the anterior and posterior cardiac loads. (8) Vasodilators: Nitrates and sodium nitroprusside exert beneficial hemodynamic effects by affecting the anteroposterior load of the heart, which are helpful in relieving heart failure decompensation and acute heart failure. However, because vasodilators also activate the sympathetic nervous system and the renin-angiotensin system, long-term application may aggravate heart failure, and therefore are not suitable for routine use in patients with chronic stable heart failure. If the patient also combined with angina pectoris or hypertension can be used vasodilators. (9) cyclic adenosine monophosphate (cAMP)-dependent positive inotropic drugs: increase myocardial contractility by increasing intracellular cAMP levels, and also have peripheral vasodilator effects, short-term application has good hemodynamic effects, mainly used in patients with acute decompensated heart failure. These drugs have arrhythmogenic effects, and long-term, intermittent intravenous infusion of these drugs is not advocated for the treatment of chronic stable heart failure. The development of heart failure is a continuous process, is a difficult to treat but preventable disease. The focus of heart failure prevention and treatment is prevention and early intervention. Early interventions targeting patients’ blood pressure, blood glucose, lipids, and smoking can reduce the occurrence of heart failure and prevent the progression of heart failure from one stage to the next, which can contribute positively to improving patient prognosis and reducing overall healthcare costs.