Management – Overview

The goals of chronic HF management are to relieve symptoms, improve quality of life, prevent hospitalizations, and prolong survival. Treatment involves a combination of pharmacologic and non-pharmacologic interventions. Medications aim to antagonize neurohormonal activation, the key driver of HF progression.

First-line pharmacotherapy centers on 4 medication classes with proven mortality benefits: ACE inhibitors/ARBs/ARNIs, beta-blockers, aldosterone antagonists, and SGLT2 inhibitors. Diuretics relieve congestion but do not impact long-term outcomes. Device therapy like CRT and ICDs improve outcomes in select patients. Managing comorbidities like hypertension, CAD, arrhythmias, diabetes, and CKD is also crucial.

Beyond medications, sodium/fluid restriction, close monitoring, patient education, exercise/rehabilitation, and multidisciplinary disease management programs help maximize outcomes. Treatment should be individualized based on HF subtype (HFrEF vs HFpEF), symptom severity, comorbidities, and other patient factors. Frequent re-evaluation and dose titration are key to optimizing care.