Cardiovascular

Medicines for Heart failure

A long-term condition in which the heart cannot pump blood around the body as well as it should, causing breathlessness, tiredness and fluid build-up — managed with proven medicines that relieve symptoms and, in many cases, improve survival.

Education and reference only. This explains which medicines are used and why, in plain language — it deliberately contains no doses and is not a substitute for advice from your doctor or pharmacist. Always discuss your own treatment with a qualified clinician, and check the BNF and the product labelling for prescribing detail.

Written by Meds Global Health Clinical Team · Clinically reviewed by Dr Muhammad Suffyan, MB BS, Founder & Clinical Director · Last reviewed · How we review

Quick answer

What is Heart failure?

Heart failure does not mean the heart has stopped; it means it is not pumping as effectively as it should, so the body and lungs do not get the blood flow they need. Typical symptoms are breathlessness, tiredness, and swelling of the ankles or legs from fluid build-up.

  • How it is treated: Treatment aims to relieve symptoms, keep people out of hospital and, where possible, help them live longer.
  • Self-care: Weighing yourself regularly to catch fluid build-up early, limiting salt and excess fluid as advised, staying as active as able, stopping smoking and getting recommended vaccinations all help control symptoms and reduce hospital admissions.
  • When to seek help: Sudden severe breathlessness, chest pain, fainting or rapid weight gain with worsening swelling needs urgent assessment — call 999 for severe breathlessness or chest pain.

What it is

Heart failure does not mean the heart has stopped; it means it is not pumping as effectively as it should, so the body and lungs do not get the blood flow they need. Typical symptoms are breathlessness, tiredness, and swelling of the ankles or legs from fluid build-up. It is often caused by a previous heart attack, long-standing high blood pressure, heart-valve disease or an abnormal rhythm. A key distinction guides treatment: in heart failure with reduced ejection fraction, the main pumping chamber is weakened and empties poorly, whereas in heart failure with preserved ejection fraction the chamber pumps reasonably but is stiff and fills poorly. An ultrasound scan of the heart (echocardiogram) and a blood test help confirm the diagnosis and which type it is.

How it is treated

Treatment aims to relieve symptoms, keep people out of hospital and, where possible, help them live longer. For reduced ejection fraction there is a well-established set of "foundation" medicines — often called the four pillars — that work together and are introduced and built up steadily under supervision, because as a group they improve survival as well as symptoms. Fluid overload is eased separately with a water tablet, which makes people feel better but does not change the long-term outlook. For preserved ejection fraction the evidence is narrower, but SGLT2 inhibitors are now recommended, alongside managing blood pressure, weight, rhythm and other conditions. Care is shared between GP and specialist heart-failure teams, with regular review of symptoms, weight, kidney function and blood salts.

For this condition, these medicines

Medicine classes used for Heart failure

Each links to a full, dose-free guide — what it is, how it works, who can and cannot use it, side effects, interactions and FAQs.

ACE inhibitors Cardiovascular A foundation therapy in reduced ejection fraction; they ease the heart's workload and improve survival. ARBs Cardiovascular An alternative foundation option when an ACE inhibitor is not tolerated, typically because of cough. Sacubitril/valsartan Cardiovascular An ARNI that can replace an ACE inhibitor or ARB in reduced-ejection-fraction heart failure to further improve outcomes. Beta-blockers Cardiovascular A foundation therapy; specific heart-failure beta-blockers slow and protect the heart and improve survival. SGLT2 inhibitors Endocrine / Cardiovascular Now a foundation therapy that reduces hospital admissions and is also recommended in some preserved-ejection-fraction cases. Spironolactone Cardiovascular / Renal A mineralocorticoid-receptor antagonist used as foundation therapy to improve survival in reduced ejection fraction. Loop diuretics Cardiovascular / Renal Relieve fluid overload and breathlessness; they ease symptoms but do not by themselves improve the long-term outlook. Ivabradine Cardiovascular An option for selected people who remain in sinus rhythm with a heart rate that stays high despite other treatment. Digoxin Cardiovascular Used in selected people, particularly where atrial fibrillation also needs rate control.

Symptom checker

Symptoms that can point to Heart failure

Heart failure can be one cause of these symptoms. Each guide explains the other possible causes and the red-flag warning signs that mean you should get urgent help:

Shortness of breathA feeling of not being able to get enough air, breathing faster or harder than normal, or …Swollen anklesSwollen ankles and legs are usually caused by fluid building up in the tissues, which can …Blue lips or skinA bluish or grey tinge to the lips, tongue, face or skin that means the body is not gettin…Swollen or bloated abdomenA tummy that feels full, tight, distended or visibly larger than usual — most often from t…Breathlessness when lying downBecoming short of breath when lying flat, and needing to prop up on pillows or sit to brea…Finger clubbingA gradual change in the fingertips and nails, where the nail bed softens, the nail curves …

Clinical formulas & tools

Calculators used in Heart failure

Risk scores and formulas that inform assessment and treatment decisions in this condition:

NYHA Functional ClassFunctional severity of heart failure.eGFR (CKD-EPI 2021)Estimated GFR, race-free creatinine equation.

By active ingredient

Specific medicines used for Heart failure

Dose-free guides to individual active ingredients used in heart failure — what each is, how it works, how to take it, and its advantages and disadvantages:

RamiprilA common ACE inhibitor used for high blood pressure and heart failure, and to protect the …BisoprololA heart-selective beta-blocker used in heart failure, to control heart rate in atrial fibr…LisinoprilA common once-daily ACE inhibitor used for high blood pressure and heart failure, and to p…LosartanAn angiotensin-receptor blocker (ARB) for high blood pressure and heart failure, often use…CandesartanA widely used angiotensin-receptor blocker (ARB) for high blood pressure and heart failure…FurosemideA strong "water tablet" (loop diuretic) used to relieve fluid overload in heart failure an…DapagliflozinAn SGLT2 inhibitor that lowers blood sugar by removing glucose in the urine, and also prot…EmpagliflozinAn SGLT2 inhibitor that lowers blood sugar through the kidneys and protects the heart and …PerindoprilA once-daily ACE inhibitor for high blood pressure and heart failure, and to protect the h…MetoprololA beta-blocker used for high blood pressure, heart failure and irregular heart rhythms; ne…ValsartanAn angiotensin-receptor blocker (ARB) for high blood pressure and heart failure, often use…EnalaprilAn ACE inhibitor for high blood pressure and heart failure; can cause a dry cough and is a…CarvedilolA beta-blocker used mainly in heart failure (started low and built up slowly) and for high…NebivololA heart-selective beta-blocker with some blood-vessel-relaxing action, used for high blood…CaptoprilThe original, short-acting ACE inhibitor for high blood pressure and heart failure; now le…BumetanideA powerful 'water tablet' (loop diuretic) that clears excess fluid in heart failure, easin…TorasemideA loop diuretic ('water tablet') taken in the morning to remove excess fluid in heart fail…MetolazoneA potent thiazide-like water tablet used, often with a loop diuretic, to clear stubborn fl…EplerenoneA potassium-sparing medicine that blocks aldosterone, used in heart failure and sometimes …HydralazineA vasodilator that relaxes artery walls, used for high blood pressure and in heart failure…AmilorideA mild, potassium-sparing water tablet, often combined with a thiazide diuretic.…DobutamineAn intravenous medicine used in hospital to make a failing or weakened heart pump more str…DopexamineAn intravenous medicine used in hospital to help a weak heart pump and to relax blood vess…EnoximoneAn intravenous medicine used in hospital to help the heart pump in severe heart failure th…ChlorothiazideA thiazide 'water tablet' used to lower high blood pressure and reduce fluid retention.…Ethacrynic acidA strong 'water tablet' that helps the body lose excess fluid and salt, used when furosemi…SacubitrilA neprilysin inhibitor used only in a fixed combination with valsartan to treat heart fail…SotagliflozinA medicine that blocks two sugar-handling transporters, used in heart failure and in diabe…VericiguatAn oral tablet used to treat chronic heart failure, added to other heart-failure medicines…DigoxinA long-established heart medicine that slows a fast pulse in atrial fibrillation and can h…SpironolactoneA water tablet that removes excess fluid while holding on to potassium — used in heart fai…IvabradineA medicine that slows the heart rate without lowering blood pressure — used in some people…Sacubitril/valsartanA two-in-one heart-failure medicine that improves symptoms and survival — used in place of…

Beyond medication

Lifestyle and self-care

Weighing yourself regularly to catch fluid build-up early, limiting salt and excess fluid as advised, staying as active as able, stopping smoking and getting recommended vaccinations all help control symptoms and reduce hospital admissions.

When to get help

When to see a doctor

Sudden severe breathlessness, chest pain, fainting or rapid weight gain with worsening swelling needs urgent assessment — call 999 for severe breathlessness or chest pain. Gradually worsening symptoms, or a steady rise in your daily weight, should prompt early contact with your heart-failure team or GP.

999Emergency — call 999 or go to A&E
111Urgent advice — call NHS 111 or use 111 online
GPNon-urgent — see your GP or pharmacist

Not sure how urgent it is? It is always OK to call NHS 111 for advice, day or night.

Answers

Heart failure: frequently asked questions

What medicines are used for heart failure?

For the common reduced-ejection-fraction type, the foundation medicines are an ACE inhibitor (or ARB, or the ARNI sacubitril-valsartan), a heart-failure beta-blocker, a mineralocorticoid-receptor antagonist such as spironolactone, and an SGLT2 inhibitor. Loop diuretics are added to control fluid, and ivabradine or digoxin are used in selected people.

What is the difference between reduced and preserved ejection fraction?

Ejection fraction is the proportion of blood the main pumping chamber squeezes out with each beat. In reduced ejection fraction the chamber is weakened and empties poorly; in preserved ejection fraction it pumps reasonably but is stiff and fills poorly. The distinction matters because the medicines proven to help differ between the two.

Why am I on so many heart tablets?

In reduced-ejection-fraction heart failure, several "foundation" medicines work in different ways and, taken together, do more to relieve symptoms and prolong life than any one alone. They are introduced and built up gradually so your body adjusts and your kidneys and blood salts can be monitored.

Does a water tablet treat the heart failure itself?

A loop diuretic clears excess fluid, which quickly eases breathlessness and swelling, but it does not by itself improve the underlying pump or the long-term outlook. That is why it is used alongside the foundation medicines rather than instead of them.

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Sources

Where this is drawn from

  • NICE NG106: Chronic heart failure in adults: diagnosis and management.
  • NICE CKS: Heart failure.

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