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Demystifying Heart Failure: Medications as a key part of treatment

In this seventh post in the Demystifying Heart Failure series, physician Randall Stafford and graduate student Min Joo Kim outline key medications.

To live well with heart failure, diet, exercise, and medication are all essential.

The two different types of heart failure -- diastolic and systolic -- require different approaches to medications. As a quick refresher, systolic heart failure occurs when the heart has a problem with pumping a sufficient amount of blood to the body. Diastolic heart failure occurs as a result of the heart becoming too stiff to work efficiently. In this blog, we will explore how each type of heart failure is treated.

A central goal of heart failure medications is to lower pressure in the heart. This is critical because increased pressure can add strain to an already weakened heart. These same medications are often used to lower blood pressure for those with hypertension.

Systolic heart failure patients have a set list of drug classes to take, all of which work through different pathways to lower blood pressure. The three general classes, followed by the most common type of drug for the class, are:

  • Beta-blockers, which work to reduce blood pressure by blocking the effects of the epinephrine, a hormone that can constrict some blood vessels.  The most frequently used beta-blockers for heart failure are carvedilol (brand name Coreg) and metoprolol (Toprol).
  • ACE inhibitors and related drugs also work to lower blood pressure by allowing blood vessels to open up. Lisinopril and losartan are the most used drugs of this type.
  • Diuretics also lower blood pressure by increasing urine production. This allows the body to get rid of extra fluid. Common drugs are furosemide (Lasix) and spironolactone.

For most patients with systolic heart failure, these three types of drugs work together, although sometimes one or two of them is sufficient.

Treatment of diastolic heart failure focuses on symptoms such as fatigue and shortness of breath. However, this is not a simple task. Often, doctors and patients will have frequent visits to adjust the concentration of drugs or change the type to find the best medications and best doses. Let's check in on Mr. J, a 72-year-old, to learn more.

Mr. J has diastolic heart failure and a long history of high blood pressure. He visits the clinic every six weeks to make sure that his dosage of medication is working for him. He is on furosemide (Lasix), a diuretic, to reduce his blood volume.

For Mr. J and his doctor, the main concern is finding the right concentration of furosemide to manage his symptoms of fatigue and shortness of breath. At 20 mg of furosemide, Mr. J's blood pressure is still too high, but at 60 mg Mr. J experiences feelings of light-headedness. They have recently settled on 40 mg as the right amount to balance out these symptoms of under- and over-treatment.

Like Mr. J, some diastolic heart failure patients can be on just one class of blood pressure lowering medications. Conversely, there are also many patients who take all three classes of beta-blockers, ACE inhibitors, and diuretics -- the medications prescribed depend on the severity and presence of the symptoms, creating a unique treatment plan for each patient.

However, no matter how many medications are prescribed, the effects cannot be seen if you do not take them. Consistent medication taking can be difficult.

"If you're having bad side effects that reduce quality of life, it's critical to let your doctor know," said Randall Stafford, MD, PhD, an internal medicine specialist at Stanford Medicine. "Being consistent with heart failure medications should be a priority and often requires help from set routines, family members, pill boxes, and phone alerts."

Medications are one of the most important ways of treating heart failure and preventing further progression of the disease. Along with the changes in diet and physical activity, finding ways to be consistent with medication taking is a skill most heart failure patients need to work on to have the best outcomes.

This is the seventh in a series of blog posts, Demystifying Heart Failure, to help patients and family members better understand and help mitigate heart failure. The next blog will provide the series conclusion.

Min Joo Kim is a master's degree student in Community Health and Prevention Research at Stanford studying the patient experience for those with chronic conditions and identifying barriers to treatment. Randall Stafford, MD, PhD, professor of medicine, focuses on strategies to improve chronic disease treatment, including engaging patients in their own health care.

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