Heart failure treatment combines daily medicines, fluid and salt management, treatment of the underlying cause, and sometimes devices or procedures. For heart failure with reduced ejection fraction, four medicine groups, often called the four pillars, lower the risk of hospitalization and death. In Sugar Land and Katy, treatment is tailored to your heart failure type, symptoms and other conditions.
Medically reviewed by
Board-certified cardiologist · Katy & Sugar Land, TX
Fellowship-trained in cardiovascular disease, interventional cardiology, echocardiography and advanced heart failure and transplant cardiology. Former Assistant Professor of Cardiology at McGovern Medical School.
Goals of heart failure treatment
Treatment aims to help you feel better and do more, keep you out of the hospital, protect and sometimes strengthen the heart muscle, and help you live longer. According to the NHLBI, treatment depends on the type and severity of heart failure and may include medicines, lifestyle changes, devices and procedures.
Heart failure medicines: the four pillars
For heart failure with reduced ejection fraction (HFrEF), guideline-directed medical therapy (GDMT) combines four classes of medicine, each shown to improve survival:
| Medicine class | Examples | How it helps |
|---|---|---|
| ARNI, or ACE inhibitor / ARB | Sacubitril-valsartan; lisinopril; losartan | Relaxes blood vessels, reduces strain and helps the heart remodel |
| Heart failure beta blocker | Carvedilol, metoprolol succinate, bisoprolol | Slows the heart, protects against stress hormones and rhythm problems |
| Mineralocorticoid receptor antagonist (MRA) | Spironolactone, eplerenone | Reduces fluid and scarring in the heart |
| SGLT2 inhibitor | Dapagliflozin, empagliflozin | Reduces hospitalizations, protects the kidneys; used with or without diabetes |
Doses are started low and increased step by step at follow-up visits while checking blood pressure, heart rate, kidney function and potassium. Reaching the best tolerated doses matters as much as starting the medicines.
Diuretics (water pills such as furosemide or torsemide) relieve swelling and breathlessness but are adjusted to your weight and symptoms. Other medicines may be added for selected patients, such as hydralazine with isosorbide dinitrate, ivabradine, vericiguat or digoxin.
For heart failure with preserved EF (HFpEF), treatment focuses on SGLT2 inhibitors, diuretics for fluid, blood pressure control, weight management, and treatment of atrial fibrillation, sleep apnea and diabetes. Some patients benefit from an MRA or ARNI.
- Weight gain of 2 to 3 pounds in a day or about 5 pounds in a week
- More swelling, more breathlessness or needing more pillows
- Dizziness or very low blood pressure readings after a medicine change
Call 911 for severe breathlessness, chest pain, fainting or pink frothy mucus.
Devices and procedures
- Implantable cardioverter-defibrillator (ICD) for people at high risk of dangerous rhythms, usually with an EF of 35 percent or less despite medicines.
- Cardiac resynchronization therapy (CRT), a special pacemaker that coordinates the heart’s pumping in people with certain EKG patterns.
- Treatment of blocked arteries with angioplasty and stenting when coronary disease contributes.
- Valve repair or replacement for significant valve disease.
- Rhythm control for atrial fibrillation, including cardioversion.
- Advanced therapies for stage D heart failure; see advanced heart failure care.
Lifestyle treatment you control
- Weigh yourself every morning and report a gain of 2 to 3 pounds in a day or about 5 pounds in a week.
- Limit sodium, as advised by your care team.
- Follow any fluid limit you have been given.
- Take medicines exactly as prescribed; do not stop them because you feel better.
- Stay active with a plan; cardiac rehabilitation is recommended for many patients.
- Avoid NSAID pain relievers such as ibuprofen and naproxen, which can worsen fluid retention.
- Stop smoking and limit alcohol.
- Get recommended vaccines, such as flu and pneumonia.
More tips in living with heart failure.
Why close follow-up matters
Heart failure care is not one visit. Medicines are adjusted over weeks to months, lab work is monitored, and an echocardiogram is repeated to see whether the heart is improving. Some patients see their EF rise substantially with full treatment, which can change whether they need devices.
Heart failure treatment in Sugar Land and Katy
Dr. Adnan Khalid completed fellowship training in advanced heart failure and transplant cardiology. At our Sugar Land office on Tarrington Avenue and our Katy office on the Grand Parkway, we start and adjust guideline-based medicines, perform EKG and echocardiogram testing in the office, follow device patients and coordinate hospital-based care when needed. Learn more about our heart failure treatment services and our Sugar Land cardiologist page.
Katy office: 410 W Grand Pkwy S, Suite 4D, Katy, TX 77494
Sugar Land office: 7102 Tarrington Ave, Suite 505, Sugar Land, TX 77479
Phone: (713) 258-6111
We also see patients from Fulshear, Richmond, Rosenberg, Stafford, Missouri City and west Houston.
Want to make sure you are on the right heart failure medicines?
A heart failure review can check whether your treatment matches current guidelines. Request a visit in Sugar Land or Katy.
Having symptoms right now? Call 911. Do not wait for an appointment.
Frequently asked questions
What is the best treatment for heart failure?
For heart failure with reduced EF, the foundation is four medicine classes: an ARNI or ACE inhibitor/ARB, a heart failure beta blocker, an MRA and an SGLT2 inhibitor, plus diuretics for fluid. Treatment is tailored to each person.
What are the four pillars of heart failure treatment?
ARNI (or ACE inhibitor/ARB), evidence-based beta blocker, mineralocorticoid receptor antagonist and SGLT2 inhibitor.
Can heart failure be treated without medication?
Lifestyle changes are essential but are not a substitute for medicines, which reduce hospitalization and improve survival.
Do I need a defibrillator for heart failure?
An ICD may be recommended if your ejection fraction stays at 35 percent or below despite optimal medicines, or if you have had a dangerous rhythm.
How is HFpEF treated?
With SGLT2 inhibitors, diuretics for fluid, blood pressure and weight control and treatment of related conditions such as atrial fibrillation and sleep apnea.
Can my ejection fraction improve with treatment?
Yes. Many patients see their EF improve with full guideline-based treatment and correction of the underlying cause.
How often will I need follow-up visits?
Often every few weeks while medicines are being adjusted, then less often once you are stable.
Trusted health resources
- Heart Failure: Treatment, National Heart, Lung, and Blood Institute (NIH)
- Heart Failure, MedlinePlus, U.S. National Library of Medicine
- Heart failure, MedlinePlus Medical Encyclopedia
- Living With Heart Failure, National Heart, Lung, and Blood Institute (NIH)
Medical disclaimer: This article is for general education and is not a diagnosis or a substitute for care from your own doctor. If you think you may be having a heart attack, stroke or another emergency, call 911 right away.
