Managing HF

You can live well,
even with heart failure.

                                                                                                                                                                                                                                                                                                                                                        

Managing Heart Failure


There are several aspects to managing heart failure.

A healthy lifestyle
Doctors would commonly encourage patients to introduce healthier habits into their daily routine, such as:

 

Keeping a good level of physical activity1

                                                                                                                                                                                                                                                                                                         

 

Avoid or be conscious of high-intensity activities, and take adequate rest periods2

                                                                                                                                                                                                                                                                                                         

 

Eating a good and balanced diet to lower cholesterol, sodium levels and reduce weight3

                                                                                                                                                                                                                                                                                                         

 

5 portions of fruit and vegetables a day3

                                                                                                                                                                                                                                                                                                         

 

Alcohol should be limited3

 

Always start slow and make sure that you discuss with your doctor before making any changes to your diet or exercise regime.

Treatment options
There are several medical approaches to treat heart failure, but the main types include:

Medication - there are several different medications that you may be prescribed, depending on your symptoms. Some include4,5,7:

  • ACE inhibitors/Angiotensin receptor blockers/Angiotensin receptor neprilysin inhibitors
  • Beta blockers
  • Mineralcorticoid receptor antagonists
  • Diuretics
  • Digoxin

Based on latest clinical data, newer options like SGLT2i are also added to further reduce cardiovascular death and heart failure-related hospitalisations8.

Device implants - several devices can be implanted to help heart function. They include4,6:

  • CRT (biventricular pacing) - a type of pacemaker that sends electrical impulses to both of the heart’s lower chambers to help them pump more efficiently
  • Implantable Cardioverter Defibrillator (ICDs) - monitors heart rhythm and restarts the heart with a shock if it stops due to irregular rhythm
  • VADs (ventricular assist devices) - a mechanical pump that helps the heart pump blood from the ventricles to the rest of the body

Surgery - Some patients may benefit from surgery e.g.9:

If they have blockage of their coronary arteries as the cause of the heart failure, then bypass surgery may be needed

If they have heart valve disease causing heart failure, repair or replacement of the valve by surgery may be needed

References

  1. ESC. Exercise training as therapy for chronic heart failure. Available from: https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-14/Exercise-training-as-therapy-for-chronic-heart-failure. Last accessed 16 September 2020.
  2. BHF. Living with heart failure. Available from: https://www.bhf.org.uk/informationsupport/support/practical-support/living-with-heart-failure. Last accessed 16 September 2020.
  3. BHF. Healthy eating. Available from: https://www.bhf.org.uk/informationsupport/support/healthy-living/healthy-eating. Last accessed 16 September 2020.
  4. NHS. Heart failure treatment. Available at: https://www.nhs.uk/conditions/heart-failure/treatment/. Accessed 2 September 2020.
  5. American Heart Association. Medications Used to Treat Heart Failure. Available from: https://www.heart.org/en/health-topics/heart-failure/treatment-options-for-heart-failure/medications-used-to-treat-heart-failure. Accessed 3 September 2020.
  6. American Heart Association. Devices and Surgical Procedures to Treat Heart Failure. Available from: https://www.heart.org/en/health-topics/heart-failure/treatment-options-for-heart-failure/devices-and-surgical-procedures-to-treat-heart-failure. Last accessed 2 September 2020.
  7. Heart Failure Matters. Heart Failure Medicines. Available from: https://www.heartfailurematters.org/en_GB/What-can-your-doctor-do/Heart-failure-medicines. Last accessed 10 March 2021.
  8. Seferovic PM et al. Eur J Heart Fail. 2020. doi:10.1002/ejhf.2026
  9. Manuscript from Dato Dr David Chew Soon Ping