Heart failure: usual medication and warning signs
Which medicines are used in heart failure, why they should not be stopped and which signs mean it is time to get medical advice.
In short
- Heart failure is usually treated with a combination of medicines that improve symptoms and reduce hospital admissions and deaths.
- Diuretics relieve fluid retention; other groups, such as beta blockers, protect the heart in the long term.
- Weigh yourself every morning: sudden weight gain, more swelling or more breathlessness are signs to call the doctor or nurse.
- Do not stop or change your medication on your own and ask before taking anti-inflammatories such as ibuprofen.
Heart failure medication combines several medicines that are taken every day and should not be stopped even when the person feels well. Alongside the medication, checking weight and symptoms every day helps to pick up any worsening in time.
It is a common condition in older people, who often take other medicines as well. This guide explains, in general terms, what each group of medicines is for and which warning signs the family should know. Doses and changes are always decided by the medical team.
| What will you find in this article? |
Which medicines are used in heart failure?
In heart failure with reduced ejection fraction, the core treatment combines, whenever possible, several groups of medicines that have been shown to reduce hospital admissions and deaths. Diuretics are added to relieve congestion.
| Group | Examples | What it is for |
|---|---|---|
| ACE inhibitors or ARBs | Enalapril, ramipril, candesartan, valsartan | Reduce the strain on the heart |
| Sacubitril/valsartan | Fixed dose combination | An alternative to ACE inhibitors or ARBs in some cases |
| Beta blockers | Bisoprolol, carvedilol, nebivolol | Slow the heart down and protect it |
| Mineralocorticoid receptor antagonists | Spironolactone, eplerenone | Add protection when symptoms persist |
| Gliflozins (SGLT2 inhibitors) | Dapagliflozin, empagliflozin | Reduce admissions for heart failure |
| Diuretics | Furosemide | Remove excess fluid; relieve symptoms but do not reduce deaths |
Not everyone takes all of these medicines: it depends on the type of heart failure, other conditions and how well they are tolerated.
Why should the medication not be stopped even if I feel well?
Many of these medicines protect the heart in the long term, even though their effect is not noticeable from one day to the next. Hospital information materials stress taking the medication on time and not stopping it without speaking to the doctor.
These treatments also usually start at low doses that the doctor increases gradually up to the target dose or the highest dose tolerated. That is why the regimen often changes in the first weeks or months, and it is easy to make mistakes if boxes pile up at home.
- Do not stop or reduce a medicine on your own.
- If you notice dizziness, severe tiredness or another effect that worries you, mention it to your doctor.
- Go for the blood tests you are asked to have: with some of these medicines kidney function, potassium and blood pressure are monitored.
Which warning signs should prompt me to seek advice?
A rapid rise in weight is often the first sign that fluid is building up. An information leaflet from hospitals in Granada advises seeking advice if weight rises by more than 1 kg in a day or more than 2 kg in 2 or 3 days; your team may give you its own threshold.
Contact your doctor or nurse if any of these signs appear:
- Sudden weight gain.
- Swelling of the feet, ankles or abdomen.
- Passing less urine each day.
- Breathlessness at rest or needing more pillows to sleep.
- More tiredness than usual or a persistent dry cough.
- Symptoms you think may be caused by the medication.
Call 112 if there is chest pain, severe difficulty breathing, bluish lips or skin, or loss of consciousness.
Which daily habits help the treatment work?
The medication works better alongside a few simple habits: weighing yourself every day, eating little salt and keeping an eye on other medicines that can make the condition worse.
- Weigh yourself every morning before breakfast, on the same scales, and write the result down.
- Cut down on salt: it encourages fluid retention.
- Keep track of how much you drink if your doctor has told you to.
- Have the flu vaccine every year.
- Tell your doctor if you take anti-inflammatories, steroids or other medicines: they can make heart failure worse. Ibuprofen and naproxen, for example, are often not safe with this condition.
If you would like to know more about anti-inflammatories, read what NSAIDs are and how they work.
A practical example: Rosa after a hospital stay
Take the case of Rosa, 79, who returns home after a hospital stay for heart failure with a diuretic, a beta blocker, a gliflozin and five other medicines. Over the following weeks her cardiologist increases the dose of her beta blocker.
- Her son leaves scales and a notebook by her bed so she can write down her weight every morning.
- They remove the boxes from her previous treatment from the house so old and new doses do not get mixed up.
- One morning her weight has gone up by 2 kg in three days and her ankles are more swollen: Rosa calls her health centre that same day.
- When Rosa forgets a tablet, they follow the leaflet, as we explain in what to do if you forget a dose.
How can IMA Health help?
When the regimen changes often and there are many medicines, having them prepared dose by dose reduces mistakes. IMA Health coordinates with a specialised pharmacy that prepares the medication by day and time in a personalised dosage system, delivers it to the home and provides personalised follow-up, including coordination with the pharmacy when the doctor changes a dose.
Sources
- SESCAM (Castilla-La Mancha): Third step in the treatment of heart failure, 2022 (Spanish)
- San Cecilio University Hospital (Granada): advice for people with heart failure (Spanish)
- MedlinePlus: Discharge after heart failure (Spanish)
- MedlinePlus: Palliative care for heart failure (Spanish)
- NHS: Heart failure, treatment
This article is for information only and does not replace advice from your doctor or pharmacist.