How is Heart Failure Diagnosed?

A person with suspected heart failure should be assessed by a cardiologist. Diagnosis is usually based on symptoms, physical examination, an echocardiogram to assess heart structure and ejection fraction, blood tests such as BNP or NT-proBNP, an ECG and basic tests of kidney function and electrolytes. Chest X-ray, cardiac MRI or coronary imaging may be used when further evaluation of the cause or severity is required.

These test results also help guide treatment selection and medication monitoring.

How is Heart Failure Treated Based on Severity?

Treatment intensity generally increases as symptoms become more limiting, fluid retention worsens or hospital admissions become more frequent. Severe or advanced heart failure may require hospital-based or device-based treatment in addition to long-term medicines.

The table below summarises the usual treatment approach for heart failure according to clinical severity:

Severity Typical Treatment Approach
Mild or stable Long-term heart failure medicines, treatment of associated conditions, lifestyle measures and regular monitoring.
Moderate Optimisation of multiple medicine classes, diuretics for congestion, closer monitoring and assessment for selected device therapy.
Severe or acutely worsening Hospital assessment, intravenous diuretics or other supportive treatment, close monitoring and evaluation for cardiac devices or procedures.
Advanced or end-stage Specialist management and assessment for advanced therapies such as inotropic support, ventricular assist devices, heart transplantation or symptom-focused care.

Types of Heart Failure and Their Treatment

Treatment of heart failure also differs according to left ventricular ejection fraction because different types of heart failure respond differently to medicines. Diuretics may be added across types when fluid retention is present.

The table below outlines the main ejection-fraction-based types of heart failure and their usual treatment approach:

Type Treatment Approach
HFrEF - reduced ejection fraction Foundational heart failure medicines, diuretics when congested and selected additional medicines or cardiac devices.
HFmrEF - mildly reduced ejection fraction SGLT2 inhibitors and diuretics when required. Other heart failure medicines may also be considered in suitable patients.
HFpEF - preserved ejection fraction SGLT2 inhibitors, diuretics for congestion and treatment of blood pressure, atrial fibrillation, kidney disease, diabetes and other contributing conditions.
HFimpEF - improved ejection fraction Continued heart failure treatment is generally recommended because stopping therapy may increase the risk of relapse.

Other Treatments for Heart Failure

Other treatments for heart failure are given below:

  1. Diuretic Therapy Diuretics, such as furosemide, reduce excess fluid in the lungs and body and are used to relieve congestion and swelling.

  2. Intravenous Treatment Patients with acute worsening may require hospital treatment with intravenous diuretics and other medicines under close monitoring.

  3. Implantable Cardioverter-Defibrillator (ICD) An ICD may be recommended for selected patients at high risk of dangerous ventricular arrhythmias and sudden cardiac death.

  4. Cardiac Resynchronisation Therapy (CRT) CRT uses a specialised pacemaker system to improve the coordination of heart contractions in selected patients.

  5. Coronary Revascularisation Angioplasty or coronary artery bypass surgery may be considered when significant coronary artery disease is contributing to impaired heart function.

  6. Valve Repair or Replacement Surgical or catheter-based treatment may be required when severe valve disease contributes to heart failure.

  7. Ventricular Assist Device A left ventricular assist device (LVAD) can provide mechanical support in selected patients with advanced heart failure.

  8. Heart Transplantation In selected patients with advanced heart failure who remain unwell despite advanced treatment, heart transplantation may be considered.

  9. Cardiac Rehabilitation Supervised rehabilitation can improve exercise capacity and support long-term cardiovascular management. Treatment may also include management of atrial fibrillation, coronary artery disease, hypertension, diabetes, kidney disease and sleep-related breathing disorders where relevant.

Oral Medications for Heart Failure

Medicines for heart failure should be given depending on the type of heart failure, blood pressure, kidney function, potassium level and other clinical factors.

Oral medications for heart failure are listed below:

  • Angiotensin Receptor-neprilysin Inhibitor (ARNI): Sacubitril/valsartan.

  • ACE Inhibitors: Enalapril, lisinopril and captopril.

  • Angiotensin II Receptor Blockers (ARBs): Losartan, valsartan and candesartan.

  • Evidence-based Beta Blockers: Carvedilol, bisoprolol and metoprolol succinate.

  • Mineralocorticoid Receptor Antagonists (MRAs): Spironolactone and eplerenone.

  • SGLT2 Inhibitors: Dapagliflozin and empagliflozin.

  • Loop Diuretics: Furosemide and torsemide for fluid retention.

  • Ivabradine: May be considered for selected patients with HFrEF and an elevated heart rate.

  • Hydralazine and Isosorbide Dinitrate: May be used when first-line renin-angiotensin system medicines cannot be used or in specific patient groups.

  • Digoxin: May be considered in selected patients for symptom or heart-rate management.

  • Vericiguat: May be considered for selected high-risk patients with worsening chronic HFrEF.

  • Potassium Supplements: May be required when treatment or fluid loss causes low potassium levels.

The four foundational medicine classes for HFrEF are ARNI-based renin-angiotensin system inhibition, evidence-based beta blockers, MRAs and SGLT2 inhibitors. Kidney function, blood pressure and serum potassium require monitoring during treatment.

Ayurvedic and Alternative Treatments for Heart Failure

No Ayurvedic, herbal or alternative therapy should replace evidence-based heart failure treatment. Patients considering complementary therapies should first discuss them with their cardiologist because some products may affect blood pressure, kidney function, potassium levels or prescribed medicines.

Possible supportive approaches for treatment of heart failure include:

  • Yoga or breathing exercises

  • Meditation and stress-management techniques

  • Supervised physical activity or cardiac rehabilitation

  • Ayurvedic herbal formulations prescribed by a qualified AYUSH practitioner

Herbal or alternative products should not be started without medical advice, particularly in patients taking diuretics, anticoagulants or multiple heart medicines.

Home Care Treatments for Managing Heart Failure

Home care supports medical treatment and can help identify worsening fluid retention early. These include:

  • Take prescribed medicines regularly and do not stop them without medical advice.

  • Monitor body weight regularly when advised by the treating team.

  • Record sudden weight gain and report it to the doctor.

  • Follow the recommended sodium restriction.

  • Follow personalised advice regarding daily fluid intake.

  • Attend regular cardiology and laboratory follow-up appointments.

  • Monitor blood pressure and heart rate when advised.

  • Follow the prescribed physical activity or cardiac rehabilitation programme.

  • Keep an updated list of medicines and doses.

It is recommended to seek medical advice promptly if breathlessness, swelling or fatigue worsen.

How Long Does Treatment for Heart Failure Take?

Heart failure usually requires long-term treatment, while hospital-based therapies and procedures may have shorter treatment periods. Duration varies according to the type of heart failure, treatment response and procedure performed.

The table below provides approximate durations for common heart failure treatments:

Treatment Approximate Duration
Long-term heart failure medicines Often continued for years or lifelong.
Medicine initiation and dose optimisation Commonly several weeks to about 3 months, depending on tolerance and response.
Diuretic treatment Short-term or long-term, depending on fluid retention.
Intravenous treatment for acute worsening Usually hours to several days during hospitalisation.
Cardiac rehabilitation Commonly several weeks to a few months.
ICD or CRT implantation One procedure followed by long-term device monitoring.
Ventricular assist device therapy Long-term, depending on whether it is used as a bridge to transplantation or ongoing support.
Heart transplantation One operation followed by lifelong follow-up and immunosuppressive treatment.

Heart Failure Treatment Side Effects

Side effects vary according to the treatment for heart failure used. Common side effects may include the following:

  • Dehydration, low blood pressure, low potassium or sodium and changes in kidney function.

  • Dizziness, changes in kidney function and raised potassium levels.

  • Persistent cough in some patients and, rarely, angioedema.

  • Tiredness, dizziness, slow heart rate and temporary worsening of symptoms during dose adjustment.

  • Breast tenderness or enlargement with spironolactone.

  • Genital infections, dehydration and other medicine-specific adverse effects.

  • Nausea, confusion or abnormal heart rhythms when blood levels become excessive.

  • Infection, bleeding, lead-related complications or the need for later device replacement.

  • Bleeding, infection, blood clots and device-related complications.

  • Rejection, infection and long-term adverse effects from immunosuppressive medicines.

Regular blood tests and follow-up help detect treatment-related problems early.

Lifestyle Changes for Managing Heart Failure

Lifestyle measures should complement, not replace, prescribed treatment for heart failure. Lifestyle changes for managing heart failure are given below:

  • Limit sodium intake according to medical advice.

  • Follow personalised fluid recommendations.

  • Maintain a healthy body weight.

  • Monitor weight when advised by the healthcare team.

  • Participate in medically approved physical activity.

  • Consider structured cardiac rehabilitation.

  • Stop smoking and avoid tobacco products.

  • Limit or avoid alcohol when advised.

  • Control diabetes, hypertension and other associated conditions.

  • Maintain regular sleep and seek assessment for suspected sleep apnea.

  • Keep vaccinations up to date according to medical advice.

  • Attend scheduled cardiology follow-ups.

Triggers That Can Worsen Symptoms of Heart Failure

Common triggers that can worsen the symptoms of heart failure include the following:

  • Missing prescribed medicines

  • Excess salt intake

  • Excess fluid intake when fluid restriction has been advised

  • Uncontrolled high blood pressure

  • Heart rhythm disorders

  • Coronary artery problems or a heart attack

  • Infections

  • Worsening kidney function

  • Certain medicines that cause fluid retention or affect heart function

  • Excess alcohol intake

  • Uncontrolled diabetes

  • Anaemia or thyroid disorders

  • Delayed medical assessment when symptoms worsen

Patients should inform their doctor before starting over-the-counter medicines, herbal products or supplements.

Treatment Cost of Heart Failure in India

Heart failure treatment costs in India vary considerably according to severity and the treatment required. Stable cases managed mainly with doctor consultations, investigations and long-term medicines may cost from several thousand rupees per month, while hospitalisation, ICD or CRT implantation, LVAD therapy and transplantation can substantially increase expenses.

When advanced disease is present, a heart transplant may cost approximately ₹20 lakh to ₹35 lakh in private hospitals. Actual costs may vary by hospital, city, ICU stay, device requirements, complications and long-term medicines.

Does Health Insurance Cover Treatment of Heart Failure in India?

Yes. Health insurance provides coverage for heart failure. It may cover hospitalisation, in-patient diagnostic investigations, prescribed procedures and eligible cardiac treatments up to the policy's sum insured. However, coverage for pre-existing heart failure or related cardiovascular conditions depends on the policy. The exact coverage may vary from policy to policy.

Critical illness insurance plans also cover heart failure, for which a lump sum benefit is paid on the diagnosis of the condition. A waiting period of up to 90 days applies to these plans, along with a survival period of up to 30 days.

In case heart failure has been diagnosed before policy purchase, a pre-existing disease waiting period of up to 36 months applies. Patients should check their policy wordings to know about the coverage, waiting periods, sub-limits, exclusions, co-payments, and coverage for devices or transplants.

Frequently Asked Questions (FAQs)

  • Q1. Can heart failure be cured permanently?

    Ans: The possibility of reversing or substantially improving heart dysfunction depends on the underlying cause of heart failure. However, many patients require long-term treatment to control symptoms, reduce hospitalisation and prevent further deterioration. Treatment should not be stopped without a cardiologist's advice.

  • Q2. Which treatment is most effective for heart failure?

    Ans: There is no single best treatment for heart failure for every patient. For HFrEF, guideline-directed therapy commonly includes an ARNI or other appropriate renin-angiotensin system inhibitor, an evidence-based beta blocker, an MRA and an SGLT2 inhibitor.

  • Q3. How long does the treatment for heart failure take?

    Ans: Treatment for heart failure is usually long- term. Medicines may be continued for years or lifelong, while dose optimisation often occurs over weeks to approximately three months in clinically stable patients.

  • Q4. Can heart failure be treated without surgery?

    Ans: Yes. Many patients with heart failure are treated primarily with medicines, lifestyle measures and regular follow-up. Surgery or device-based treatment is reserved for selected patients with specific causes, severe symptoms or advanced heart failure.

  • Q5. What is the latest standard approach to HFrEF treatment in heart failure patients?

    Ans: A major current heart failure treatment approach is the early use and optimisation of four foundational treatment classes: an ARNI-based or other appropriate renin-angiotensin system inhibitor, an evidence-based beta blocker, an MRA and an SGLT2 inhibitor.

  • Q6. How often should heart failure treatment be reviewed?

    Ans: Follow-up frequency depends on heart failure symptom severity, recent hospitalisation, treatment changes and kidney function. Patients usually require closer monitoring when medicines are initiated or when doses are adjusted.

  • Q7. Can heart failure medicines be stopped after symptoms improve?

    Ans: No medicine should be stopped without medical advice. Patients with improved ejection fraction may still require continued guideline-directed treatment to reduce the risk of heart failure relapse.

  • Q8. Is Ayurvedic treatment enough to manage heart failure?

    Ans: No. Ayurvedic treatment should not replace prescribed heart failure therapy and should only be used as complementary care after medical advice.

  • References

    • https://www.mayoclinic.org/diseases-conditions/heart-failure/diagnosis-treatment/drc-20373148

    • https://www.nhlbi.nih.gov/health/heart-failure/treatment

    • https://www.heart.org/en/health-topics/heart-failure/treatment-options-for-heart-failure

    • https://my.clevelandclinic.org/health/diseases/17069-heart-failure-understanding-heart-failure

    • https://emedicine.medscape.com/article/163062-treatment

    • https://www.apollohospitals.com/procedures/heart-transplant

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