"When I started a heart failure clinic 30 years ago, few patients lived more than five years, and most of those with advanced heart failure died within two years. Now I see patients with advanced heart failure living 20 years," says Dr. Lynne Warner Stevenson, a heart failure specialist at Harvard-affiliated Brigham and Women's Hospital.
Clinical trials have identified therapies that most effectively control symptoms and prevent death. But not all therapies work in every person, and not person with heart failure needs all these treatments.
Virtually everyone with heart failure that affects the heart's left pumping chamber should take a beta blocker plus an ACE inhibitor or angiotensin-receptor blocker (ARB). These drugs have been shown to slow the progression of heart failure and decrease the amount of work the heart must do to pump effectively.
After that, treatment must be personalized. Other options include:
· Diuretics for those who retain fluid
· Hydralazine-nitrate if symptoms are not controlled with a beta blocker and an ACE inhibitor or ARB
· Eplerenone or spironolactone to help prevent the formation of fibers that stiffen heart muscle
· Cardiac resynchronization therapy to better coordinate the heart's contractions and improve its pumping power
· An implantable cardioverter-defibrillator to prevent sudden death in those who have survived a cardiac arrest, and possibly others
For more information on heart failure treatments, read the full-length article: "Treatments for heart failure"
Also in the October 2012 issue of the Harvard Heart Letter:
When high blood pressure should be treated: not as straightforward as it seems
Cardiac rehab is key to recovery from bypass surgery or heart attack, but few women participate
A "smart pill" that signals if you've taken your medications
The Harvard Heart Letter is available from Harvard Health Publications, the publishing division of Harvard Medical School, for $20 per year. Subscribe at www.health.harvard.edu/heart or by calling 877-649-9457 (toll-free).
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