Comprehensive management of heart failure

Treatment for heart failure is tailored to the cause of the condition, the heart’s function, the symptoms and the individual’s needs. It may involve a combination of medication, managing fluid retention, physical activity and specialist care.

What does the treatment for heart failure involve?

Heart failure occurs when the heart is unable to fill with or pump blood efficiently enough to meet the body’s needs.

This does not mean that the heart has stopped, nor does it mean that everyone has the same problem. In some cases, the heart’s ability to contract is reduced; in others, the heart appears to retain its strength but is stiffer and has difficulty filling with blood.

For this reason, treatment does not consist of a single medication or an identical regimen for all patients. It is tailored by combining various measures aimed at relieving symptoms, preventing fluid build-up, reducing the risk of further episodes of decompensation, and addressing the mechanisms that contribute to the progression of the disease.

Where possible, the underlying cause of heart failure is also treated, such as coronary heart disease, a valvular disorder or certain arrhythmias.

Why treatment is tailored to each individual

Heart failure can arise from a wide variety of causes. These include coronary artery disease, a previous heart attack, persistent high blood pressure, valvular heart disease, certain arrhythmias and diseases affecting the heart muscle itself.

Identifying the cause helps determine whether, in addition to medical treatment for heart failure, it is necessary to perform valve surgery, improve blood flow through the coronary arteries, treat an arrhythmia or address another condition responsible for the heart’s deterioration.

Echocardiography provides essential information about the structure and function of the heart. One of the key measurements it provides is the ejection fraction, which estimates the proportion of blood ejected by the left ventricle with each contraction.

This measure helps to classify different types of heart failure and guides part of the treatment, but it is not the only factor taken into account. Symptoms, blood pressure, heart rate, the presence of congestion, kidney function and associated conditions also play a role.

Diabetes, kidney disease, atrial fibrillation, anaemia, iron deficiency, obesity and high blood pressure are common in these patients and can affect both the treatment and how well they tolerate it.

Medicines used to treat heart failure

Medication is one of the cornerstones of treatment, but the types used depend on the type of heart failure and the clinical characteristics of each individual.

In certain patients, medicines that act on different mechanisms of the disease may be combined. These include drugs that act on the renin-angiotensin system, beta-blockers, mineralocorticoid receptor antagonists and SGLT2 inhibitors.

Although their names may seem complex, the important thing is to understand that they do not all perform exactly the same function. Some reduce specific mechanisms of cardiac overload, whilst others modify the heart rate or help to protect the cardiovascular and renal systems.

Depending on the situation, treatments may also be used for certain arrhythmias, iron deficiency or other conditions that influence the progression of heart failure.

The treatment regimen is established gradually and reviewed in light of tolerance, blood pressure, renal function, potassium levels, heart rate and clinical response.

The role of diuretics

Diuretics are used when there is a build-up of water and sodium in the body. This fluid retention may manifest as swelling of the legs, weight gain, a feeling of abdominal fullness or increased shortness of breath.

These medicines promote the elimination of excess fluid and can improve symptoms relatively quickly. Their dose, however, needs to be individually adjusted to avoid both inadequately treated congestion and excessive fluid loss.

Too high a dose can lead to dehydration, a drop in blood pressure or impaired kidney function. For this reason, diuretics serve a different purpose from other medicines designed to alter the long-term course of the disease.

How medication is started and adjusted

Treatment is usually introduced and adjusted gradually. The aim is not simply to reach a specific dose, but to find an effective combination that can be safely maintained.

During this process, blood pressure, heart rate, kidney function and potassium and sodium levels are monitored. The team also monitors changes in shortness of breath, fluid retention, the ability to carry out physical activity and any symptoms such as dizziness or weakness.

A moderate change in blood pressure or in a blood test result does not automatically mean that a medicine must be discontinued. The team can assess hydration status, review other treatments or adjust doses before deciding on the next course of action.

Fluid and dietary management

Fluid retention may develop gradually and precede a more obvious worsening of symptoms. In some patients, regular weight monitoring can help to detect changes when this forms part of the plan agreed with the healthcare team.

What matters is not a single figure, but how it compares to the patient’s usual weight and whether it is accompanied by increased swelling, shortness of breath or a need to sleep in a more upright position.

Salt intake can also influence fluid retention and blood pressure. The general recommendation is to avoid excessive intake, but the extent of restriction should be tailored to each individual.

In elderly, frail or patients with a poor appetite, an excessively restrictive diet can compromise nutritional status. Similarly, fluid restriction is not universally recommended and is usually reserved for specific clinical situations.

Smoking should be avoided, and alcohol consumption requires individual assessment. Where alcohol contributes to damage to the heart muscle, it may be necessary to stop drinking completely.

Physical activity and cardiac rehabilitation

Shortness of breath and tiredness can gradually lead to a reduction in activity, but prolonged inactivity contributes to a loss of muscle strength and may further reduce functional capacity.

When heart failure is stable, tailored physical activity can improve stamina, independence and exercise tolerance. The intensity and type of exercise are tailored to the patient’s physical capacity, symptoms and associated conditions.

Cardiac rehabilitation provides a structured environment in which supervised exercise, health education, risk factor management and support for adopting sustainable habits can be combined.

During an episode of decompensation, it may be necessary to temporarily reduce activity. Exercise should also be stopped and reassessed if chest pain, significant dizziness, severe palpitations or clearly disproportionate shortness of breath occur.

Why follow-up is part of the treatment

Heart failure can change even during periods when the person appears to be stable. Check-ups allow us to check whether the treatment plan remains appropriate and to detect signs of congestion or deterioration before a major relapse occurs.

During consultations, breathing, exercise tolerance, weight and any fluid retention are assessed. Blood pressure, heart rate, kidney function and certain laboratory parameters are also monitored.

Follow-up also enables doctors to assess tolerance to medication, adjust doses, simplify complex treatment regimens and address any concerns regarding the patient’s progress and the symptoms that should prompt a consultation.

Following a hospital stay, the first few weeks are particularly important as relatively rapid changes to medication or the management of fluid retention may be necessary.

For certain patients, telemonitoring can complement face-to-face consultations. Recording parameters at home is only useful when there is a care pathway in place capable of interpreting changes and deciding whether action is required.

When devices or procedures may be needed

Medication forms the basis of treatment for many people, but some situations require additional strategies.

Where there is a high risk of certain ventricular arrhythmias, an implantable cardioverter-defibrillator may be considered. In selected patients with poorly coordinated ventricular contraction, cardiac resynchronisation therapy may be indicated, aimed at improving the heart’s synchrony.

The team is involved in the assessment of rhythm disturbances and pacemakers where these are indicated.

Where valvular heart disease or coronary artery disease contributes significantly to heart failure, it may be necessary to consider a catheter-based procedure or surgery.

These decisions do not depend on a single imaging result or an isolated figure. They take into account symptoms, response to medical treatment, heart function, the risks of the procedure and the reasonably expected benefit.

What benefits can a well-tailored treatment offer?

A properly personalised treatment plan can reduce shortness of breath and congestion, improve the ability to carry out everyday activities and lower the risk of further episodes of decompensation and hospital admissions. Certain medicines can also influence the course of the disease and reduce the risk of cardiovascular complications.

In some people, heart function may improve considerably, particularly when a reversible cause is corrected or there is a good response to treatment. This recovery does not necessarily mean that the disease has disappeared.

The heart may still be vulnerable, and stopping treatments that have contributed to the improvement may lead to a relapse. Therefore, an improvement in symptoms or heart function should not lead to stopping medication on one’s own initiative.

Outcomes depend on the cause, the type of heart failure, its severity, any associated conditions and the individual’s response.

Adverse effects and treatment safety

Possible adverse effects depend on the medicines used and the clinical situation. These may include an excessive drop in blood pressure, dizziness, impaired kidney function or changes in potassium levels.

Some treatments may reduce the heart rate too much, and an excessive dose of a diuretic may lead to dehydration or kidney damage.

The occurrence of an adverse effect does not automatically mean that treatment must be permanently discontinued. In many cases, the dose, timing, other medicines or fluid balance can be adjusted.

Medical devices and procedures carry different risks, which must be explained in relation to the specific intervention. For this reason, there is no single risk profile applicable to ‘heart failure treatment’ as a whole.

It is also important to seek advice before using anti-inflammatory drugs, certain supplements or herbal products, as some may increase fluid retention, impair kidney function or interfere with cardiovascular medication.

What happens as heart failure progresses

In some people, the condition may progress despite comprehensive and correctly adjusted treatment. Symptoms may appear with increasingly minor exertion, hospital admissions may become recurrent, or the function of other organs may begin to deteriorate.

When the condition reaches a certain stage, it is referred to as advanced heart failure, and a specialist assessment of new treatment options may be required.

Depending on the clinical profile, ventricular assist devices, heart transplantation or other advanced strategies may be considered. These alternatives require a thorough assessment and are only appropriate for certain patients.

Palliative care may also be incorporated when there are symptoms that are difficult to control, a significant burden of illness or complex decisions to be made. Its involvement can coexist with cardiological treatment and help to manage symptoms and tailor care to the individual’s priorities.

Situations requiring a specific assessment

Kidney disease

Renal function influences both the choice and adjustment of numerous treatments. It may also deteriorate during a period of decompensation or vary when diuretics and other medicines are changed.

Diabetes

Diabetes is common in people with heart failure and forms part of the overall assessment. Some current treatments may offer benefits in both contexts, whilst metabolic control must be coordinated with the rest of the management strategy.

Atrial fibrillation and other arrhythmias

Heart rhythm disturbances can worsen symptoms or contribute to decompensation. Management of heart rate, rhythm and embolic risk forms part of the overall cardiovascular treatment.

Iron deficiency and anaemia

Anaemia and iron deficiency can contribute to fatigue and reduced functional capacity. Identifying these conditions enables an assessment of whether specific treatment is required.

Frailty and nutritional risk

In older people or those with limited physical reserves, an overly restrictive approach to diet or fluid intake may be counterproductive. The plan must balance the management of oedema with the preservation of strength, independence and nutritional status.

Signs requiring medical assessment

You should contact your healthcare team if you experience a gradual increase in shortness of breath, increased swelling of the legs or abdomen, a sudden change in weight compared to usual, or the need to sleep in a more upright position.

Persistent dizziness, palpitations, a significant reduction in urine output, or side effects that make it difficult to continue treatment should also be assessed.

Severe shortness of breath at rest, persistent chest pain, loss of consciousness, sudden confusion or a rapid deterioration in general health require urgent medical attention.

Specialists involved

The treatment of heart failure requires continuity of care, as the treatment strategy may change depending on the progression of symptoms, cardiac function, response to medication and the onset of other conditions.

At the Publio Cordón Memorial Hospital, the Clinical Cardiology Unit forms the cornerstone of this care pathway. The unit routinely provides diagnosis, treatment and structured follow-up for heart failure. Among its specialists is Dr Javier de Juan Bagudá, who specialises specifically in heart failure, heart transplantation and cardiomyopathies.

The Advanced Cardiac Imaging Unit provides information on the structure and function of the heart, including ventricular assessment, cardiomyopathies and heart failure. This information helps to characterise the type of condition and guide treatment decisions.

Where arrhythmias are present or device-based therapy may be indicated, the Electrophysiology and Arrhythmias Unit becomes involved in the process to assess rhythm disturbances and strategies such as resynchronisation or specific implantable devices.

If coronary or valvular disease contributes to heart failure, other units within Cardiology and Cardiac Surgery may be involved in assessing interventional or surgical treatments. Cardiac Surgery specifically includes advanced heart failure within its overall care strategy.

Internal Medicine can play a significant role where multiple chronic conditions are present, as the hospital specifically includes the coordination of patients with heart failure, diabetes or kidney disease within this speciality.

Depending on individual needs, Endocrinology and Nutrition, Urology, Nursing and other support teams may also be involved. Not everyone requires involvement from all these areas: the care pathway is tailored to the type and cause of heart failure, any associated conditions and the therapeutic needs that arise during follow-up.

Preguntas frecuentes

Do you have to take medication for heart failure for the rest of your life?

Often, part of the treatment is continued for many years and, in some people, indefinitely. Even when symptoms improve or heart function is restored, there may still be a risk of heart failure recurring. For this reason, medication should not be stopped simply because the person is feeling better; any decision to withdraw, replace or adjust medication must be based on the cause of the condition, its progression and the response to treatment.

What is the purpose of diuretics in heart failure?

Diuretics help to eliminate excess sodium and water when fluid retention occurs and can improve symptoms such as swelling, weight gain or shortness of breath. Their main function is to control fluid retention. They are not a substitute for other medicines which, when indicated, act on the mechanisms of the disease and can reduce the risk of hospitalisation or other cardiovascular complications.

Do all people with heart failure need to limit their fluid intake?

No. Fluid restriction is not routinely recommended for all people with heart failure. It may be considered in certain situations, for example in cases of severe heart failure, difficult-to-control congestion or low blood sodium levels. The appropriate amount should be determined on an individual basis, as excessive restriction can also lead to dehydration, low blood pressure or kidney damage.

Should salt be completely eliminated from the diet?

It is not usually necessary to cut it out completely. It is important to avoid excessive salt intake as this can lead to fluid retention and make it difficult to manage heart failure. The degree of restriction should be tailored to the patient’s clinical condition, usual diet and nutritional status; an excessively restrictive diet can be particularly problematic for older, frail people or those at risk of malnutrition.

Can you exercise if you have heart failure?

Yes, once the condition is clinically stable. Adapted physical activity and, where indicated, cardiac rehabilitation can improve functional capacity and quality of life. The type and intensity of exercise should be tailored to each person’s symptoms and circumstances. During an episode of decompensation or in the event of symptoms such as chest pain, severe dizziness or disproportionate shortness of breath, it may be necessary to temporarily stop exercising and seek medical advice.

What happens if your blood pressure drops whilst taking the medication?

A low blood pressure reading alone does not necessarily mean that a medicine needs to be withdrawn. The healthcare team must assess whether there are symptoms such as dizziness, weakness or fainting, as well as the patient’s hydration status, oedema, kidney function and overall medication regimen. In some cases, it may be necessary to adjust doses or review other treatments, but any changes must be made under medical supervision.

Can I take ibuprofen or other anti-inflammatory medicines if I have heart failure?

It is advisable to consult your healthcare team first. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can cause sodium and water retention, raise blood pressure, affect kidney function and reduce the effectiveness of diuretics; as a result, they may worsen heart failure in some people. This precaution also applies to over-the-counter medicines and certain combinations used to treat pain or cold symptoms.

Medical information for general guidance

This information sheet aims to help you understand how the treatment of heart failure is organised, the role played by different medicines, how fluid retention is managed, and why regular monitoring allows the treatment strategy to be adapted over time. It also explains when devices, procedures or advanced options may be required.

At the Publio Cordón Memorial Hospital, we believe it is important for medical information to be accurate, understandable and useful in guiding each person through their care journey. Our specialists devote part of their work to explaining conditions, tests and treatment options in an accessible way, helping patients and their families to better understand each stage and participate with greater confidence in decisions about their health. This commitment to knowledge and public outreach is also part of our commitment to .

The information in this fact sheet describes the general principles of heart failure treatment. The combination of medicines, treatment targets, physical activity and the use of medical devices or procedures must be tailored to each individual’s specific situation, taking into account the type and cause of the condition, symptoms, kidney and heart function, associated conditions and the individual’s clinical progression.