HFpEF is a subtype of HF in which the patients have an EF above 50%, and it is projected to become the dominant type of HF in the coming years. Clinical manifestations of HFpEF are similar to other types of HF. HFpEF is a complex pathology influenced by the severity of comorbidities such as diabetes, obesity, and hypertension. HFpEF is greatly affected by cardiac fibrosis induced by extrinsic factors such as diabetes and hypertension. Cardiac fibrosis, in combination with other processes significantly contributes to HFpEF pathogenesis.

How many suffer from heart failure and heart failure with preserved ejection fraction?

According to recent reports, 26 million people live with heart failure worldwide. In the United States, heart failure affects approximately 6.2 million adults and is the leading cause of hospitalization among people over the age of 65. Similarly, in Europe, an estimated 15 million people are affected by heart failure, with heart failure being the leading cause of hospitalization in people over the age of 65 in the European Union. In both US and Europe, approximately 50% of HF patients have heart failure with preserved ejection fraction (HFpEF).

How is heart failure with preserved ejection fraction diagnosed?

Heart failure with preserved ejection fraction (HFpEF) is diagnosed through a thorough evaluation that involves a medical history, physical examination, and various tests, such as electrocardiogram, echocardiogram, and cardiopulmonary exercise testing. EF and end-diastolic volume are assessed. In addition to these diagnostic tools, circulating biomarkers that indicate the presence and severity of heart failure may also be used. Common biomarkers for HFpEF include brain natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide (NT-proBNP). In case of uncertainty and to establish etiology, the patient is referred to further testing such as echocardiographic testing (diastolic stress test), hemodynamic measurements, cardiac MRI, and genetic testing.

How is heart failure with preserved ejection fraction treated?

Treatment for HFpEF typically involves managing the underlying conditions that contribute to the development of heart failure, such as hypertension, diabetes, and obesity, through lifestyle changes and medications. For symptom management, various medications may be prescribed, such as diuretics, beta-blockers, ACE inhibitors, or angiotensin receptor blockers (ARBs). According to the American College of Cardiology, several studies have explored the benefit of mineralocorticoid receptor agonists, such as spironolactone, the benefit of angiotensin receptor neprilysin inhibitors (ARNi), such as sacubitril-valsartan and more recently, the benefit of sodium-glucose cotransport-2 inhibitors (SGLT2i) such as empagliflozin and dapagliflozin, showing promising results in the reduction of risk of HF hospitalization or composite CV death. Current treatments focus on improving symptoms and quality of life, reducing the risk of complications, and addressing the underlying conditions that contribute to the development of heart failure. Still, no anti-fibrotic treatment has yet been approved for the treatment of HF.

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