Heart Failure: Stage C

Piedmont Augusta's Advanced Heart Failure Center

1350 Walton Way
Augusta, GA 30901-2629
Phone: 706.774.7855 
Fax. 706.364.0516 
Hours: 8 a.m.-4:30 p.m.

Patients have a structural abnormality and current or previous symptoms of heart failure, including shortness of breath, fatigue, and difficulty exercising. Treatment includes those for Stage A and B plus:

• Restrict dietary sodium (salt). Lowering sodium in the diet can help diuretics work better.
• Exercise training and cardiac rehabilitation for appropriate patients.
• ACE inhibitor, or ARB as an alternative.
• Beta blockers (bisoprolol, carvedilol, and sustained release metoprolol).
• Diuretics are recommended for most patients, with loop diuretics such as furosemide generally being the first-line choice.
• Aldosterone inhibitors are recommended for many patients. Digitalis may be prescribed for some patients.
• A hydralazine and nitrate combination (BiDil) may be used for African-American patients who are taking an ACE inhibitor and beta blocker and who still have heart failure symptoms.
• Anticoagulants for patients who have heart failure and atrial fibrillation and are at risk for stroke.
• ICDs may be considered for patients with very low EF or those who have had dangerous arrhythmias.
• Cardiac resynchronization therapy (pacemaker), with or without ICD, for some patients.
• Ivabradine (Corlanor) may help with heart failure by decreasing the heart rate. It is more likely to be used after treatment with an ACE inhibitor or ARB, beta blocker, and spironolactone have been maximized generally when the resting heart rate remains above 70 beats per minute.
• Sacubitril-valsartan (Entresto) is called an angiotensin-neprilysin inhibitor. This drug may be used when other heart failure medicines have been maximized, the EF is low, and BNP levels remain elevated.