Core approach

1. Confirm the type and severity of heart failure
   • Reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF) have overlapping but somewhat different treatment plans.
   • Monitor weight, swelling, breathlessness, blood pressure, kidney function, electrolytes, HbA1c, and glucose.
2. Diabetes medicines preferred in heart failure
   • SGLT2 inhibitors such as dapagliflozin or empagliflozin are often strongly favored. They improve heart-failure outcomes in people with or without diabetes and may reduce hospitalization risk.
   • Watch for dehydration, genital fungal infections, low blood pressure, and rare ketoacidosis. They may need temporary withholding during severe illness, prolonged fasting, or major surgery.
3. Diabetes medicines generally avoided or used cautiously
   • Thiazolidinediones: pioglitazone and rosiglitazone can cause fluid retention and may worsen heart failure. Usually avoid in symptomatic HF.
   • Saxagliptin and possibly alogliptin: generally avoid or use carefully in established heart failure because of concern for HF hospitalization.
   • Metformin is commonly acceptable if heart failure is stable and kidney function is adequate, but is usually paused during acute decompensated HF, shock, severe hypoxia, or serious kidney injury.
   • Insulin and sulfonylureas can be used when needed, but hypoglycemia is a concern. Doses sometimes need adjustment with kidney disease or poor appetite.
   • GLP-1 receptor agonists can help glucose control and weight reduction, particularly with obesity or atherosclerotic cardiovascular disease, but they are not a replacement for heart-failure medicines.
4. Use guideline-based heart-failure treatment Depending on blood pressure, kidney function, potassium, and HF type, this often includes:
   • SGLT2 inhibitor
   • Evidence-based beta-blocker
   • ACE inhibitor, ARB, or ARNI
   • Mineralocorticoid receptor antagonist
   • Loop diuretic, such as furosemide, for fluid congestion
   Do not stop or change these medicines without prescriber guidance.
5. Daily self-management
   • Check weight daily, ideally after urinating and before breakfast.
   • Follow the prescribed sodium and fluid plan. Avoid excess salt, including packaged and restaurant foods.
   • Take diuretics exactly as prescribed.
   • Avoid NSAID pain medicines such as ibuprofen, naproxen, and diclofenac unless a clinician specifically approves them. They can worsen fluid retention and kidney function.
   • Avoid smoking; limit alcohol.
   • Individualize glucose targets. For many people with significant HF, avoiding hypoglycemia and treatment burden matters more than very tight glucose control.

Get urgent medical help now for

• Severe or rapidly worsening shortness of breath, especially at rest
• Chest pain, fainting, confusion, blue lips, or coughing pink froth
• Rapid swelling or a weight gain around 2 to 3 lb (1 to 1.5 kg) in a day, or 5 lb (about 2 to 2.5 kg) in a week
• Very low blood sugar, persistent vomiting, or markedly high glucose with illness