Congestive Heart Failure

Aetna Better Healthâ„  Premier Plan can help you get care if you have heart failure. Heart failure is not a disease in itself. It’s a condition that happens when the heart cannot pump enough blood for your body. Common causes are coronary heart disease, high blood pressure and diabetes. We have a disease management program that helps members who have heart failure.

Everyone with heart failure needs care from a doctor. If you don’t get care, your heart could get weaker and you’ll feel very sick. You may even have to go to the hospital.

Many people manage very well with heart failure. But to make sure you feel the best you can, you must see a doctor regularly and do what the doctor tells you. We’ll work with you and your doctor to get you the right treatment.

Most people with heart failure fit into one of four groups:

Group one: A person may not have signs of heart failure or heart damage. But he or she may have other problems such as high blood pressure, diabetes or blocked blood vessels in the heart. We’ll teach you ways to live healthier if you are part of this group. Then you’ll be less likely to have heart failure.

Group two: A person's heart has been damaged. The heart is not as healthy as it could be. But the person doesn’t show signs of heart failure. Maybe the person had a heart attack or an infection in the heart. Maybe the heart valves are not working correctly. Your doctor may give you medicine called ACE inhibitors or beta blockers if you are part of this group.

Group three: A person's heart may be damaged, as in group two. The person shows signs of heart failure. We’ll teach you about having healthier habits if you are part of this group. You will learn about exercise and eating healthy. Also, your doctor may give you medicine to treat heart failure.

Group four: This is the most serious group. A person's heart may be getting weaker. It may not be able to pump blood to the body very well. Your doctor may refer you to a cardiologist (heart doctor). You may have to go to the hospital if you are part of this group.

It’s important to learn as much as you can about heart failure. To learn more about this and other diseases, just call Member Services toll-free at 1-855-676-5772 (TTY: 711). Ask to talk to your case manager.