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 (angiotensin-converting enzyme [ACE] inhibitors, diuretics, beta-blockers) 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 drugs

Drug 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
  • Slow heart rate
  • Reduced need for hospitalization
  • Heart rate too slow
  • Dangerous arrhythmias if level too high
Calcium channel blockers
  • Vasodilatation
  • Possibly reduce heart failure symptoms (diastolic heart failure)
  • Low blood pressure
  • Heart rate too slow
  • Ventricular systolic function worse
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
  • Prolong survival in combination with nitrates
  • Low blood pressure
  • Arthritis
  • Lupus-like syndrome
Nitrates
  • Vasodilatation
  • Reduce heart failure symptoms when used in combination with hydralazine
  • Low blood pressure
  • Headache
Dobutamine
  • Increase contraction of the heart
  • Vasodilatation
  • Relieve symptoms in severe end-stage heart failure
  • Ventricular arrhythmia
  • Coronary ischemia worse
  • Low blood pressure
  • Heart rate too fast
Amiodarone
  • Prevent ventricular arrhythmias
  • Slow heart rate
  • Thyroid function too high
  • Thyroid function too low
  • Lung toxicity
  • Liver toxicity
  • Eye problems
  • Skin problems
  • No survival advantage
Warfarin
  • Prevent blood clots in the heart
  • Bleeding

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. A good example of this would be a decision to be admitted to the hospital for intravenous dobutamine.

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.

Related Information

Credits

Author Robin Parks, MS
Editor Kathleen M. Ariss, MS
Editor Marianne Flagg
Associate Editor Terrina Vail
Associate Editor Pat Truman, MATC
Primary Medical Reviewer Caroline S. Rhoads, MD - Internal Medicine
Specialist Medical Reviewer Robert A. Kloner, MD, PhD - Cardiology
Last Updated August 25, 2008

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