Management of Congestive Heart Failure

Recommended Treatments

• The European Society of Cardiology recommends ACE inhibitors for symptomatic patients with HFrEF to reduce the risk of hospitalization and death 1, 2
• The European Society of Cardiology recommends beta-blockers in addition to ACE inhibitors for stable, symptomatic HFrEF patients 1, 2
• The European Society of Cardiology recommends mineralocorticoid receptor antagonists (MRAs) like spironolactone for patients who remain symptomatic despite treatment with ACE inhibitors and beta-blockers 1, 2
• The European Society of Cardiology recommends diuretics to improve symptoms and exercise capacity in patients with signs of congestion 1, 2
• Sacubitril/valsartan is recommended as a replacement for ACE inhibitors in patients who remain symptomatic despite optimal treatment 1, 2
• The American Heart Association suggests the combination of hydralazine and isosorbide dinitrate may be considered for specific patient populations 3

Medications to Avoid

• The European Society of Cardiology advises that calcium channel blockers (particularly non-dihydropyridines like diltiazem and verapamil) should be avoided in HFrEF patients as they increase the risk of worsening heart failure 1, 2, 4
• The American Heart Association recommends that NSAIDs should be avoided as they can cause sodium and water retention and blunt the effects of diuretics 3, 4, 5
• The American Heart Association suggests that thiazolidinediones increase the risk of heart failure events and should be avoided 3, 5
• The American Heart Association advises that most antiarrhythmic drugs (except amiodarone and dofetilide) should be avoided due to negative inotropic and proarrhythmic effects 3, 5

Diuretic Management

• The European Society of Cardiology recommends loop diuretics (furosemide, bumetanide, torsemide) as the preferred option over thiazides for most CHF patients due to their higher efficiency of diuresis 6
• The European Society of Cardiology suggests thiazide diuretics may be used in combination with loop diuretics for resistant cases 6
• The European Society of Cardiology recommends potassium-sparing diuretics like spironolactone over other potassium-sparing agents like amiloride or triamterene 6
• The European Society of Cardiology advises careful monitoring of electrolytes and renal function is essential when using diuretics 6