Management of Heart Failure with Preserved Ejection Fraction
Diagnostic Confirmation
- The European Society of Cardiology recommends confirming HFpEF using LVEF ≥50%, elevated natriuretic peptides, and evidence of structural heart disease 3, 1
- Transthoracic echocardiography with LV diastolic function assessment is the key diagnostic test, according to the European Heart Journal 3
First-Line Pharmacological Management
- The American College of Cardiology recommends starting dapagliflozin 10 mg daily or empagliflozin 10 mg daily immediately upon diagnosis, as they have proven mortality and morbidity benefits in HFpEF 1, 2
- Dapagliflozin reduced the composite endpoint of worsening heart failure and cardiovascular death by 18% (HR 0.82, 95% CI 0.73-0.92) and heart failure hospitalizations by 23% (HR 0.77, 95% CI 0.67-0.89) in the DELIVER trial 2
- Empagliflozin reduced heart failure hospitalization or cardiovascular death by 21% (HR 0.79, 95% CI 0.69-0.90) in EMPEROR-PRESERVED 4
Symptom Management
- The European Society of Cardiology recommends using loop diuretics at the lowest effective dose to relieve congestion and manage orthopnea/paroxysmal nocturnal dyspnea 3, 1, 2
Management of Comorbidities
- The European Society of Cardiology recommends achieving blood pressure target <130/80 mmHg using appropriate antihypertensive medications 3, 1
- The American College of Cardiology recommends prioritizing SGLT2 inhibitors for glycemic control given their additional heart failure benefits 1, 4
Non-Pharmacological Interventions
- The American College of Cardiology recommends supervised exercise training programs to improve functional capacity and quality of life (Class 1 recommendation) 5, 1, 2
- The European Society of Cardiology recommends sodium restriction to <2-3 g/day and weight reduction in obese patients 1, 3