Effective Treatments for Low Ejection Fraction: What You Need to Know

A diagnosis of low ejection fraction (EF), often a key indicator of heart failure, can be concerning. However, numerous effective treatments are available to manage the condition, improve heart function, and enhance quality of life. The primary goals of these treatments are to alleviate symptoms, slow the progression of heart failure, and reduce the risk of complications. Treatment plans are highly individualized and typically involve a multi-faceted approach combining medications, lifestyle changes, and in some cases, medical devices or surgical procedures.

Medications for Low Ejection Fraction

Medications are the cornerstone of treatment for most people with a low ejection fraction. Different classes of drugs work in various ways to reduce the strain on the heart, improve its pumping ability, and manage symptoms. A cardiologist will often prescribe a combination of the following medications.

ACE Inhibitors, ARBs, and ARNIs

This group of medications is fundamental to treating heart failure with reduced ejection fraction. Angiotensin-converting enzyme (ACE) inhibitors (e.g., lisinopril, enalapril) and angiotensin II receptor blockers (ARBs) (e.g., losartan, valsartan) work by relaxing blood vessels. This lowers blood pressure, making it easier for the heart to pump blood throughout the body. They help reduce the workload on a weakened heart, which can slow down the progression of heart failure.

A newer class of medication called angiotensin receptor-neprilysin inhibitors (ARNIs), with the most common being sacubitril/valsartan, combines an ARB with a neprilysin inhibitor. This not only relaxes blood vessels but also helps the body get rid of excess sodium and water, further reducing stress on the heart. ARNIs have been shown to be highly effective in improving outcomes for patients with low EF.

Beta-Blockers

While it might seem counterintuitive to slow down a weak heart, beta-blockers (e.g., carvedilol, metoprolol, bisoprolol) are another critical component of treatment. These medications work by blocking the effects of adrenaline, which causes the heart to beat faster and harder. By slowing the heart rate and lowering blood pressure, beta-blockers decrease the heart's oxygen demand and allow the left ventricle to fill more completely between beats. Over time, this can actually improve the heart's structure and pumping function.

Diuretics (Water Pills)

Diuretics are primarily used for symptom relief. When the heart isn't pumping effectively, fluid can build up in the body, leading to symptoms like swelling (edema) in the legs and abdomen, and shortness of breath due to fluid in the lungs. Diuretics (e.g., furosemide, bumetanide) help the kidneys remove excess salt and water from the body through urination. This reduces fluid congestion, making breathing easier and decreasing swelling, which significantly improves a person's comfort and ability to be active.

SGLT2 Inhibitors

Originally developed as diabetes medications, sodium-glucose cotransporter-2 (SGLT2) inhibitors (e.g., dapagliflozin, empagliflozin) have emerged as a powerful treatment for heart failure, even in people without diabetes. These drugs work by helping the kidneys excrete excess sugar, but they also have beneficial effects on the heart and blood vessels. They have been shown to reduce the risk of hospitalization and death from heart failure by reducing fluid retention and easing the workload on the heart, making them a key part of modern treatment strategies.

Medical Devices and Surgical Interventions

For some individuals, medications and lifestyle changes may not be enough. In these cases, advanced therapies involving medical devices or surgical procedures may be recommended to improve heart function and prevent life-threatening complications.

Implantable Cardioverter-Defibrillator (ICD)

A low ejection fraction increases the risk of dangerous, irregular heart rhythms (arrhythmias) that can cause sudden cardiac arrest. An ICD is a small device, similar to a pacemaker, that is implanted under the skin in the chest. It has wires that connect to the heart to continuously monitor its rhythm. If the ICD detects a life-threatening arrhythmia, it delivers a controlled electrical shock to restore a normal heartbeat. It acts as a safety net, providing crucial protection for individuals at high risk.

Cardiac Resynchronization Therapy (CRT)

In some people with heart failure, the electrical signals that coordinate heart contractions become disorganized. This causes the left and right ventricles to pump out of sync, making the heart's overall pumping action inefficient. Cardiac Resynchronization Therapy (CRT), also known as biventricular pacing, uses a special type of pacemaker with three leads—one for the right atrium, one for the right ventricle, and one for the left ventricle. This device sends timed electrical impulses to both ventricles, helping them contract in a more synchronized and efficient manner, which can improve ejection fraction and overall heart function.

Coronary Artery Bypass Graft (CABG) Surgery

If the low ejection fraction is caused by coronary artery disease (blockages in the heart's arteries), restoring blood flow to the heart muscle can be crucial. Coronary Artery Bypass Graft (CABG) is a surgical procedure where a surgeon takes a healthy blood vessel from another part of the body (like the leg or chest) and uses it to create a new path for blood to flow around a blocked artery. By bypassing the blockage, CABG can improve blood supply to the heart muscle, potentially improving its strength and ejection fraction.