How to Manage Heart Failure With Preserved Ejection Fraction

Highlights

• Effective pharmacologic therapy is now available to modify disease progression in HFpEF.

• After confirming the diagnosis and excluding alternatives, clinicians should aggressively manage congestion, address comorbidities, and initiate evidence-based medical treatment.

• SGLT2 inhibitors are appropriate for most patients with HFpEF, and addition of an ARNI and/or MRA may be appropriate for many.

• Exercise and lifestyle modification to facilitate weight reduction are appropriate for all patients.

Abstract

Although patients with heart failure with preserved ejection fraction (HFpEF) (left ventricular ejection fraction ≥50%) comprise nearly half of those with chronic heart failure, evidence-based treatment options for this population have historically been limited. Recently, however, emerging data from prospective, randomized trials enrolling patients with HFpEF have greatly altered the range of pharmacologic options to modify disease progression in selected patients with HFpEF. In the context of this evolving landscape, clinicians are increasingly in need of practical guidance regarding the best approach to management of this growing population. In this review, the authors build on the recently published heart failure guidelines by integrating contemporary data from recent randomized trials to provide a contemporary framework for diagnosis and evidence-based treatment of patients with HFpEF. Where gaps in knowledge persist, the authors provide “best available” data from post hoc analyses of clinical trials or data from observational studies to guide management until more definitive studies are available.