Heart failure remains a serious and incurable disease, but heart-failure treatment with medications has been a tremendous success story. "I think that the drugs we've used have made an enormous impact on people with heart failure," says Marvin A. Konstam, MD, chief of cardiology and director of cardiovascular development at Tufts-New England Medical Center. "That's something we shouldn't lose sight of."
Heart failure is a condition in which the heart can't pump blood effectively to the lungs or the rest of the body.
This can be because the person has developed a weakened heart muscle or because the heart muscle has thickened or stiffened, making it difficult to fill the heart and backing up blood into the lungs.
With heart failure, the weakened heart pumps less blood than usual, causing the kidneys and adrenal glands to produce chemicals that help the body to hold onto salt and water.
Research into heart-failure treatment with drugs has suffered a few setbacks in recent years, as medications considered to have great potential did not prove as effective as hoped. Implantable devices like defibrillators, LVADs, and biventricular pacers are also generating a great deal of excitement as new ways to treat the condition.
But given the novelty and expense of implantable devices, it's likely that heart-failure treatment for most people will consist of drugs alone in the near future, according to Michael R. Bristow, MD, PhD, from the University of Colorado Health Sciences Center. The good news is that standard drugs for heart-failure treatment are effective and new ones are under development.
Heart-failure treatment with medication depends on a person's condition, whether you suffer from the more common systolic heart failure -- in which the heart has difficulty pumping -- or the rarer diastolic heart failure -- in which the heart is stiff and has trouble expanding to fill with blood.
Both conditions are helped by angiotensin-converting enzyme inhibitors (ACE inhibitors), which in the last decade have become the linchpin of heart-failure treatment. The success of ACE inhibitors in reducing sickness and death from heart failure demonstrated the significant role that hormones play in worsening heart failure and changed the focus of heart-failure treatment.
Some of the body's natural responses to a failing heart actually cause the condition to worsen. One is the body's release of hormones that constrict the blood vessels, making it harder for the weakened heart to pump blood. ACE inhibitors and other similar drugs block the effects of these hormones and widen the vessels, easing the heart's workload.
Beta-blockers are another prominent heart-failure treatment. In addition to lowering blood pressure and decreasing heart rate, these drugs also lessen the effects of the hormones that result from heart failure. Beta-blockers are tremendously useful drugs, resulting in almost a 50% reduction in the risk of death in people with heart failure.