Chapter 24: Heart Failure Drugs

Classification frameworks such as New York Heart Association functional staging and ACCF/AHA categorization provide the clinical context for treatment selection and severity assessment. Modern heart failure pharmacotherapy centers on interrupting neurohormonal compensation mechanisms, particularly the renin-angiotensin-aldosterone system and sympathetic nervous system overactivation. Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers form foundational therapy by reducing vasoconstriction and aldosterone secretion, while the newer angiotensin receptor-neprilysin inhibitor combination demonstrates superior mortality reduction compared to conventional approaches. Beta-adrenergic antagonists deliver cardioprotective effects through sympathetic suppression and improved ventricular remodeling. Aldosterone receptor antagonists enhance survival outcomes in moderate-to-severe disease despite modest hemodynamic effects. Emerging agents including SA node inhibitors reduce symptom-driven hospitalizations, and sodium-glucose cotransporter 2 inhibitors show promise across multiple heart failure phenotypes. Positive inotropic medications such as phosphodiesterase inhibitors and catecholamine agonists enhance contractile force but carry significant arrhythmia risk and are limited to acute decompensation or bridge-to-transplant scenarios. Cardiac glycosides improve symptoms and manage concurrent atrial fibrillation through dual AV nodal effects, though their narrow therapeutic index necessitates vigilant toxicity monitoring including assessment for arrhythmias, visual and gastrointestinal manifestations, and bradycardic complications. Critical nursing practice encompasses comprehensive baseline assessment of hemodynamic parameters, electrolyte panels, renal function, and cardiac rhythm documentation. Patient education emphasizes daily weight surveillance as an indicator of fluid retention, pre-administration pulse verification for glycoside safety, medication adherence optimization, dietary sodium restriction, potassium management relative to drug therapy, and recognition of decompensation warning signs. Integration of pharmacological intervention with lifestyle modification including exercise prescription and smoking cessation strategies enables nurses to optimize outcomes in terms of symptom relief, hospitalization prevention, and survival extension.