Treatment - General Measures

These interventions reduce general risk factors that are known to lead to the progression of CHF or other comorbidities (e.g., diabetes mellitus, hypertension).

• Exercise

• Cessation of smoking, alcohol consumption, and recreational drug use

• Weight loss

• Immunization: pneumococcal vaccine and seasonal influenza vaccine

Making sure that the patient understands the pathophysiological basis of the disease improves the effectiveness of treatment and quality of life.

• Diet and fluid restriction [1]

  • Salt restriction: ≤ 1.5 g/day in stages A and B, ≤ 3 g/day in stages C and D

  • Avoidance of potassium-rich foods while taking aldosterone antagonists

  • Fluid restriction: 1.5–2 L/day in stage D patients who have edema and/or hyponatremia

• Self-monitoring and symptom recognition

  • Daily weight check: Patients with a weight gain of > 4–5 lbs (> 2 kg) within 3 days should consult a doctor.

  • Recognition of symptoms of worsening heart failure

  • Monitoring of potential medication side effects

• Awareness of travel precautions: e.g., carrying a copy of medical records and avoiding destinations with limited healthcare

The following conditions may worsen the symptoms of heart failure and accelerate progression.

• Hypertension: Treat with a target systolic BP of < 130.

• Dyslipidemia: Start statins to keep lipids within the normal range.

• Diabetes

  • Screen for hyperglycemia and implement gradual glycemic control.

  • Consider starting an SGLT2 inhibitor.

• Iron deficiency: Screen for and start iron replacement in patients with NYHA class II and III symptoms and iron deficiency. [16][38]

• Obstructive sleep apnea: Consider nocturnal continuous positive airway pressure (CPAP) therapy.

• Atrial fibrillation: Start either rate or rhythm control and consider anticoagulation.

• Coronary artery disease: Consider coronary revascularization if there is concomitant ischemic heart disease.

• Most antiarrhythmic agents

• Calcium channel blockers (except amlodipine)

• NSAIDs

• Thiazolidinediones (e.g., pioglitazone)

• Inhalation anesthetics

• Cautious selection of antidepressants due to numerous interactions and adverse effects when used with HF drugs (SSRIs may be used judiciously)

Can cause complete heart block