Heart failure with preserved ejection fraction: strategies for disease management and emerging therapeutic approaches

ABSTRACT

Approximately 50% of patients with heart failure (HF) have a preserved ejection fraction (HFpEF), and the incidence of HFpEF is increasing relative to HF with reduced ejection fraction (HFrEF). Both types of HF are associated with reduced survival and increased risk for hospitalization. However, in contrast to HFrEF, there are no approved treatments specifically indicated for HFpEF, and current therapy is largely focused on management of symptoms and comorbidities. Diagnosis of HFpEF in the outpatient setting also presents unique challenges compared with HFrEF because of factors including a high burden of comorbidities in HFpEF and difficulties in distinguishing HFpEF from normal aging. Primary care providers (PCPs) play a pivotal role in the delivery of holistic, patient-centric care from diagnosis to management and palliative care. As the prevalence of HF continues to rise in an aging population, PCPs will need to play a greater role in HFpEF care. This article will review HFpEF etiology and pathophysiology, diagnostic workup, and management of symptoms and comorbidities, with a focus on the critical role of PCPs throughout the clinical course of HFpEF.

KEYWORDS:

• Heart failure with preserved ejection fraction
• etiology
• pathophysiology
• diagnosis
• treatment and management

Acknowledgments

Medical writing and editorial assistance were provided by Traci Stuve, MA, and Madeline Pfau, PhD, of ApotheCom (Yardley, PA, USA), and Matilda Toivakka, PhD, and Brittany Jarrett, PhD, of Complete HealthVizion (Chicago, IL, USA), and was funded by Novartis Pharmaceuticals Corporation.

Declaration of funding

Novartis Pharmaceuticals Corporation provided funding for medical writing and editorial assistance and reviewed the content for medical accuracy but had no role in the preparation of the manuscript or decision to publish it.

Declaration of financial/other relationships

Neither P.P.T. nor D.G. received honorarium or other form of compensation for their participation in this project. The coauthors were involved in every stage of manuscript development and had full control over final content.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Declaration of interest

Neither P.P.T. nor D.G. received honoraria or other form of compensation for their participation in this project. The co-authors were involved in every stage of manuscript development and had full control over final content. Novartis Pharmaceuticals Corporation provided funding for medical writing and editorial assistance and reviewed the content for medical accuracy but had no role in the preparation of the manuscript or decision to publish it.