Editing Heart failure (section)

=====Other medications=====
Second-line medications for CHF do not confer a mortality benefit. [[Digoxin]] is one such medication. Its narrow therapeutic window, a high degree of toxicity, and the failure of multiple trials to show a mortality benefit have reduced its role in clinical practice. It is now used in only a small number of people with refractory symptoms, who are in atrial fibrillation, and/or who have chronic hypotension.<ref>{{cite web| url=https://www.lecturio.com/concepts/congestive-heart-failure/| title=Congestive Heart Failure| website=The Lecturio Medical Concept Library| date=7 August 2020| access-date=10 July 2021| archive-date=10 July 2021| archive-url=https://web.archive.org/web/20210710035402/https://www.lecturio.com/concepts/congestive-heart-failure/| url-status=live}}</ref><ref>{{cite web|title=Digoxin|url=https://www.drugs.com/monograph/digoxin.html|publisher=The American Society of Health-System Pharmacists|access-date=8 December 2016|url-status=live|archive-url=https://web.archive.org/web/20161221004328/https://www.drugs.com/monograph/digoxin.html|archive-date=21 December 2016}}</ref>

Diuretics have been a mainstay of treatment against symptoms of fluid accumulation, and include diuretics classes such as [[loop diuretic]]s (such as [[furosemide]]), [[thiazide-like diuretic]]s, and [[potassium-sparing diuretic]]s. Although widely used, evidence on their efficacy and safety is limited, except for [[mineralocorticoid antagonist]]s such as [[spironolactone]].<ref name="NICE2018ch6"/><ref name=vonLueder>{{cite journal | vauthors = von Lueder TG, Atar D, Krum H | title = Diuretic use in heart failure and outcomes | journal = Clinical Pharmacology and Therapeutics | volume = 94 | issue = 4 | pages = 490–8 | date = October 2013 | pmid = 23852396 | doi = 10.1038/clpt.2013.140 | s2cid = 7441258 }}</ref>

Anemia is an independent factor in mortality in people with chronic heart failure. Treatment of anemia significantly improves the quality of life for those with heart failure, often with a reduction in severity of the NYHA classification, and also improves mortality rates.<ref name=He2009>{{cite journal | vauthors = He SW, Wang LX | title = The impact of anemia on the prognosis of chronic heart failure: a meta-analysis and systemic review | journal = Congestive Heart Failure | volume = 15 | issue = 3 | pages = 123–30 | year = 2009 | pmid = 19522961 | doi = 10.1111/j.1751-7133.2008.00030.x | doi-access = free }}</ref><ref>{{cite journal | vauthors = Nunez-Gil MI, Peraira-Moral MJ |title=Anaemia in heart failure: intravenous iron therapy |journal=e-Journal of the ESC Council for Cardiology Practice |volume=10 |issue=16 |date=19 January 2012 |url=http://www.escardio.org/communities/councils/ccp/e-journal/volume10/Pages/anemia-in-heart-failure-intravenous-iron-therapy-Peraira-Moral-J-Roberto-Nunez-Gil-Ivan-J.aspx |url-status=dead |archive-url=https://web.archive.org/web/20130603124155/http://www.escardio.org/communities/councils/ccp/e-journal/volume10/Pages/anemia-in-heart-failure-intravenous-iron-therapy-Peraira-Moral-J-Roberto-Nunez-Gil-Ivan-J.aspx |archive-date=3 June 2013 |df=dmy-all |access-date=3 October 2012 }}</ref> The [[European Society of Cardiology]] recommends screening for iron deficiency and treating with [[parenteral iron|intravenous iron]] if deficiency is found.<ref name="ESC2021"/>{{rp|pages=3668–3669}}

The decision to anticoagulate people with HF, typically with left ventricular ejection fractions <35% is debated, but generally, people with coexisting atrial fibrillation, a prior embolic event, or conditions that increase the risk of an embolic event such as amyloidosis, left ventricular noncompaction, familial dilated cardiomyopathy, or a thromboembolic event in a first-degree relative.<ref name="Hunt-2005" />

[[Vasopressin receptor antagonist]]s can also treat heart failure. [[Conivaptan]] is the first medication approved by the US [[Food and Drug Administration]] for the treatment of euvolemic hyponatremia in those with heart failure.<ref name="US cardiology 2008"/> In rare cases hypertonic 3% saline together with diuretics may be used to correct hyponatremia.<ref name="US cardiology 2008"/>

[[Ivabradine]] is recommended for people with symptomatic heart failure with reduced left ventricular ejection fraction who are receiving optimized guideline-directed therapy (as above) including the maximum tolerated dose of beta-blocker, have a normal heart rhythm and continue to have a resting heart rate above 70 beats per minute.<ref name=ACC2017/> Ivabradine has been found to reduce the risk of hospitalization for heart failure exacerbations in this subgroup of people with heart failure.<ref name=ACC2017>{{cite journal | vauthors = Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Colvin MM, Drazner MH, Filippatos GS, Fonarow GC, Givertz MM, Hollenberg SM, Lindenfeld J, Masoudi FA, McBride PE, Peterson PN, Stevenson LW, Westlake C | title = 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America | journal = Circulation | volume = 136 | issue = 6 | pages = e137–e161 | date = August 2017 | pmid = 28455343 | doi = 10.1161/CIR.0000000000000509 | doi-access = free }}</ref>