Risks and Benefits of Medicines for Heart Failure
Topic Overview
Heart failure is a very serious illness that can cause
life-threatening complications and significantly limit your life span.
Fortunately, many drugs have been shown to slow the progression of heart
failure, and several drugs have been shown to prolong survival. Each of these
medicines has risks and benefits that you and your doctor will need to weigh
when you are deciding whether you should take the medicine. These are
summarized in the following table.
Benefits and risks of heart failure drugsDrug or class of drugs | Benefits | Risks |
|---|
| ACE inhibitors | - Inhibit adverse effects of angiotensin
II on the heart and blood vessels
- Reduce heart failure
symptoms
- Prolong survival
| - Low blood pressure
- Soft
tissue swelling of the face and throat, and hives (severe allergy)
-
Dry cough
- Reduced kidney function
- Increased
potassium
|
| Beta-blockers | - Reduce heart failure symptoms (ongoing
use)
- Prolong survival
- Prevent ventricular
arrhythmia
- Slow heart rate improves diastolic heart
failure.
| - Heart rate too slow
- Heart
failure symptoms worse (short-term use)
|
| Diuretics (including spironolactone) | - Reduce fluid buildup in the lungs and
legs
- Reduce heart failure symptoms
- Prolong survival
(spironolactone)
| - Low blood pressure
- Reduced
kidney function if too much fluid removed
- Low or high potassium,
magnesium, calcium
|
| Digoxin | - Decreased heart failure
symptoms
- Reduced need for
hospitalization
| - Heart rate too slow
-
Dangerous arrhythmias if level too high
|
| Calcium channel blockers | - Help your heart fill with blood more easily.
| - Slow heart rate
- Constipation or diarrhea
- Dizziness or lightheadedness
- Flushing or feeling warm
|
| Angiotensin II receptor blockers (ARBs) | - Inhibit adverse effects of angiotensin
II on the heart and blood vessels
- Reduce heart failure symptoms
- Improve survival
| - Low blood pressure
- Kidney
dysfunction
- High potassium
|
| Hydralazine | - Vasodilatation
- Reduce heart
failure symptoms
- Reduce heart
failure symptoms and lower risk of early death when used in combination with a nitrate
| |
| Nitrates | - Relieve angina (chest pain or discomfort
- Reduce heart
failure symptoms and lower risk of early death when used in combination with hydralazine
| - Low blood pressure
-
Headache
|
| Amiodarone | - Maintain regular heartbeat
| Severe side effects include: - Lung damage
- Liver damage
- More severe heartbeat problems
|
| Warfarin | - Prevent blood clots in the heart
| |
The decisions you make with your doctor should be tailored
to meet your own personal goals of treatment for your heart failure. Some
decisions are not always completely right or wrong. What is most important is
that you make informed decisions that are right for you and with which you are
comfortable.
In fact, your goals of treatment may change over
time. Early in the course of your treatment, you may want to do everything
possible to extend your life span, even if it means making your symptoms
temporarily worse. A good example of this is starting therapy with a
beta-blocker, which can make your symptoms worse during the first few weeks or
months but eventually may reduce your symptoms and prolong your survival.
But if you develop end-stage heart failure with very severe
symptoms that prevent you from doing even simple activities, you may prefer
treatments that are most effective at reducing your symptoms, even if they may
have some risk of decreasing your survival.
To help you with decision making, the most important things you can do
are: first, keep yourself well informed about the risks and benefits of the
treatments that are available to you, and second, develop a close rapport with
a doctor whose advice and opinions you trust.
Credits
| By | Healthwise Staff |
|---|
| Primary Medical Reviewer | E. Gregory Thompson, MD - Internal Medicine |
|---|
| Specialist Medical Reviewer | Theresa O'Young, PharmD - Clinical Pharmacy |
|---|
| Last Revised | August 9, 2010 |
|---|
Last Revised:
August 9, 2010
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