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Heart Failure Treatment: Medication, Lifestyle Changes, and More

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While heart failure (also called congestive heart failure) cannot be cured, early diagnosis and treatment can help improve quality and length of life.

 Treatment can also help ease symptoms of heart failure, including shortness of breath, fatigue, weight gain, and swelling in the abdomen, legs, ankles, or feet.

“Heart failure [treatment] is generally divided between people who have an ejection fraction more or less than 40 percent,” says J. Emanuel Finet, MD, a cardiologist at Cleveland Clinic. Ejection fraction (EF) is a measurement used to determine how well your heart is pumping blood based on the amount that leaves the lower half of your heart. A normal EF is 50 to 70 percent, meaning your heart is able to pump 50 to 70 percent of blood to your body. Below 40 percent indicates that your heart isn’t pumping enough blood and may be failing.

Always consult your healthcare provider to discuss a plan that best suits you and your needs before starting a treatment or combining treatments.

After diagnosing heart failure, a doctor may prescribe multiple medications to help address symptoms, improve heart function, and, in many cases, prolong life.

Medication Directly Addressing Ejection Fraction

In 2025, the U.S. Food and Drug Administration (FDA) approved finerenone (Kerendia) as a treatment for people with heart failure with a mildly reduced EF of 40 percent or greater.

In this population, finerenone is associated with a significant reduction in the rate of heart failure progression and a reduced risk of cardiovascular-related mortality.

Medications for Widening Blood Vessels

Angiotensin-converting enzyme (ACE) inhibitors widen blood vessels to lower blood pressure, improve blood flow, and reduce the workload on the heart. There are several commonly prescribed ACE inhibitors, including:

  • captopril (Capoten)
  • enalapril (Vasotec)
  • fosinopril (Monopril)
  • lisinopril (Prinivil, Zestril, and others)
Vasodilators are another type of medication that work to widen blood vessels as well as veins or coronary arteries, depending on the specific formulation. Based on your blood pressure and other symptoms, your doctor may prescribe more than one vasodilator.

Options include:
  • hydralazine (Apresoline)

  • isosorbide dinitrate (Isordil, Sorbitrate, and others)

Taking vasodilators is known to help reduce hospitalization rates in people with heart failure as well as reduce their risk of cardiovascular-related mortality.

Medications for Reducing Blood Pressure

Angiotensin II receptor blockers (ARBs) prevent blood pressure from rising. They are used as an alternative to ACE inhibitors when they can’t be tolerated. These two types of medications shouldn’t be used together. Commonly prescribed ARBs include:

  • candesartan (Atacand)
  • losartan (Cozaar or Arbli)
  • valsartan (Diovan)
Angiotensin receptor neprilysin inhibitors (ARNIs) are combination drugs consisting of a neprilysin inhibitor and an ARB.

 Neprilysin breaks down natriuretic peptides, which are substances in the body that are produced by the heart and blood vessels and increase when chronic diseases like heart failure arise.

 Inhibiting (or reducing) neprilysin helps open arteries, improve blood flow, reduce sodium retention, and decrease overall strain on the heart. Sacubitril (Entresto) is a commonly prescribed ARNI.

Beta-blockers slow your heart rate and force of contractions, which reduces blood pressure and makes the heart beat more slowly and less forcefully. Beta-blockers your doctor may prescribe include:

  • bisoprolol (Zebeta)
  • carvedilol (Coreg)
  • carvedilol phosphate (Coreg CR)
  • labetalol (Trandate)

Medications for Lowering Blood Sugar

Sodium-glucose cotransporter-2 (SGLT2) inhibitors lower blood sugar by preventing the kidneys from reabsorbing glucose back into the blood. They’re also recommended for people with heart failure and reduced EF (below 40 percent).

 A few examples of SGLT2 inhibitors include:

  • dapagliflozin (Farxiga)
  • empagliflozin (Jardiance)
  • sotagliflozin (Inpefa)

Diuretics

Diuretics, also known as water pills, reduce the amount of fluid in the body, relieving some of the heart’s workload. Aldosterone antagonists are diuretics that help the body get rid of excess water to reduce blood pressure. Commonly prescribed aldosterone antagonists include:

  • spironolactone (Aldactone)
  • eplerenone (Inspra)

Additional Medications

There are also medications and dietary supplements that don’t treat heart failure itself but support its overall management.

  • Digoxin (Digitex, Lanoxin, and others) This medication is used in some cases to treat abnormal heart rhythms (arrhythmias).

  • Statins These cholesterol-lowering drugs are often prescribed for the primary and secondary and primary prevention of coronary artery disease.

  • Supplements Because magnesium and potassium can be lost when taking diuretics, your doctor may suggest a dietary supplement to maintain healthy levels.

While surgery isn't often used to treat heart failure, it may be recommended if your condition can't be helped with medication or dietary and lifestyle changes, or if your doctor believes that’s the only way to treat your condition. For example, surgery may be recommended if you have a diseased heart valve or a blocked coronary artery.

“One of the causes of heart failure is ischemia,” said Robert P. Davis, MD, assistant professor of cardiac surgery at Yale School of Medicine in New Haven, Connecticut. “Opening up blood vessels with angioplasty technique or coronary artery bypass surgery is a treatment option for people with heart failure. Sometimes, if you reverse the ischemia, this can relieve their heart failure symptoms.”

Angioplasty

Angioplasty, also called percutaneous coronary intervention, is a catheter-based procedure that reopens blocked blood vessels.

During angioplasty, a catheter with a small balloon-like device is threaded through a vein and opened once it reaches the clogged artery. Then a small wire tube (called a stent) may be placed into the artery to keep it open. There is a slight risk of damage to the artery during this procedure, but angioplasty usually improves the condition.

Coronary Bypass

Meanwhile, coronary bypass surgery requires surgeons to utilize healthy blood vessels from another part of your body, such as a leg or the chest wall, and then attach the vessels to your diseased artery so the blood can flow around the blocked section.

Coronary bypass surgery is one of the most common types of heart surgery that is performed, according to Dr. Davis. Some more serious cases of heart failure may qualify a patient for heart valve replacement or, in extreme cases, a heart transplant.

Valve Replacement

A heart valve replacement is needed when one of your heart valves is diseased or defective, which can lead to extra strain on the heart and ultimately heart failure. A variety of replacement valves can be used, including those made from metal and plastic, as well as those made from human or animal tissue.

The surgery involves the patient being connected to a heart-lung machine while the bad valve is removed or replaced.

Heart Transplant

A heart transplant is for the most dire circumstances. “We refer to this as end-stage heart failure,” said Davis. “We've exhausted all treatment options.”

During a heart transplant, the surgeon connects you to a heart-lung machine, which takes over the functions of the heart and lungs while the damaged heart is replaced with a healthy one taken from a donor. Then the major blood vessels are reconnected, and the new heart begins working.

About 90 percent of people live for more than a year after receiving a heart transplant. But it can take several months to find a donor heart that’s a good match. Only around 4,600 people receive a transplant each year.

Devices and Implants

The following implanted devices may help improve heart function or protect against sudden cardiac arrest for some people with heart failure:

  • Biventricular Pacing Also known as cardiac resynchronization therapy, this pacemaker enables the ventricles to contract more normally and in synchrony.
  • Implantable Cardioverter Defibrillator (ICD) This surgically placed device is used in some people who have severe heart failure or serious arrhythmias. The device delivers an electric counter-shock to the heart when a life-threatening abnormal rhythm is detected.
  • Left Ventricular Assist Devices (LVADs) These battery-operated, pump-like devices are surgically implanted to help maintain the pumping ability of the heart.

Making healthier lifestyle choices is often recommended for heart health.

The Dietary Approaches to Stop Hypertension (DASH) diet limits salt, fatty meats, added sugar, and full-fat dairy products, which can have a positive impact on people with heart failure.

Weight loss can also improve cardiac function, alleviate heart failure symptoms, and potentially improve hospitalization rates in those with the condition.

 Weight loss shouldn’t stem from diet alone, though. Exercise is often needed to support healthy and sustainable weight management.
Benefits of exercise include strengthening the heart and cardiovascular system, improving blood flow, and increasing energy levels. Exercise can not only help prevent heart failure but also reduce some of the early damage caused by the condition.

 Regular exercise in people with heart failure can help decrease both hospitalization and mortality risks as well.

Some exercise guidelines for people with heart failure are as follows:

  • Walk a moderate pace for about 5–10 minutes, slowly increasing each day until you walk 30–45 minutes.
  • Rest when needed, but try not to lie down when you’re finished working out.
  • If you don’t like walking, other aerobic activities like cycling, swimming, or rowing are good alternatives.
  • Stop your exercise and notify your doctor if you have excessive shortness of breath, a rapid heart rate that doesn’t resolve after 15 minutes of rest, dizziness, or chest discomfort.
In addition to exercising regularly and maintaining a healthy weight, the following lifestyle habits can help improve heart failure symptoms and slow disease progression:

  • Avoid or limit alcohol
  • Avoid or limit caffeine
  • Check your legs, ankles, and feet for swelling daily
  • Eat a heart-healthy diet (and reduce sodium intake)
  • Get adequate rest and sleep
  • Join a support group
  • Monitor and control high blood pressure
  • Quit smoking
  • Reduce stress
  • Stay up to date on recommended vaccinations
  • Track (and potentially limit) your fluid intake

Clinical evidence supporting the use of complementary and integrative approaches in the treatment of heart failure is both limited and controversial.

That said, yoga and tai chi are considered safe and well-tolerated adjunct therapies for people with heart failure. As both exercise and methods for cardiac rehabilitation, these forms of movement pair mindfulness and stress reduction with gentle physical activity, which are beneficial for overall heart health.

In terms of dietary supplements for heart failure, omega-3 polyunsaturated fatty acids (fish oil) may be beneficial and are generally considered safe when consumed in moderation. Consult your healthcare provider before adding fish oil or any other supplement to your wellness routine.

Chest pain is a common symptom of heart failure.

 Depending on the exact cause of the pain, your healthcare provider may prescribe one or more of the medications listed in this article that help keep the arteries open, reduce blood pressure, address high cholesterol, or manage diabetes.
Lifestyle changes, like eating a healthy diet and getting regular physical activity, can also help. For some people, cardiac rehabilitation may be an option as well.

Living with a chronic health condition like heart failure is challenging. It can lead to feelings of anxiety, depression, fear, and stress.

Let your doctor know if you’re struggling to cope with the lifestyle changes, uncertainty, and physical limitations that come with heart failure. They can help by recommending resources, like a support group or a mental health professional.

  • Heart failure treatment primarily focuses on improving quality and length of life as well as easing symptoms, based on the individual and their condition.
  • A wide variety of medications are employed to treat heart failure, including ACE inhibitors and vasodilators for widening blood vessels, ARBs and beta-blockers for reducing blood pressure, diuretics for fluid reduction, and newer drugs, like finerenone and SGLT2 inhibitors.
  • Comprehensive management requires significant lifestyle changes, such as adhering to the DASH diet, achieving a healthy weight through regular exercise, quitting smoking, limiting alcohol, monitoring fluid intake, and reducing stress.
  • If medication and lifestyle changes aren’t enough, treatment may involve surgical interventions, like angioplasty, coronary bypass, valve replacement, the use of implanted devices, or a heart transplant for end-stage cases.

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