Treatment for Heart Failure with Preserved Ejection Fraction with Atrial Fibrillation and COPD

First-Line Disease-Modifying Therapy

• The American College of Cardiology recommends SGLT2 inhibitors as the first-line disease-modifying therapy for patients with HFpEF who have atrial fibrillation and COPD, due to their significant reductions in heart failure hospitalizations and composite cardiovascular outcomes, as evidenced by the DELIVER and EMPEROR-PRESERVED trials 1
• SGLT2 inhibitors have demonstrated significant reductions in heart failure hospitalizations and composite cardiovascular outcomes in patients with HFpEF 4

Management of Atrial Fibrillation in HFpEF

• Anticoagulation should be prescribed based on CHA₂DS₂-VASc score to prevent thromboembolic events, as recommended by the American Heart Association 5

Management of COPD in HFpEF Patients

• Optimize COPD management according to standard guidelines while being mindful of potential drug interactions, as recommended by the American College of Cardiology 1
• Beta-blockers for AF rate control should be used cautiously in patients with COPD, with preference for cardioselective agents, as recommended by the American Heart Association 5

Monitoring and Follow-up

• Regularly assess volume status, renal function, and electrolytes, especially with MRA therapy, to guide treatment adjustments 4