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Clinical focus: Cardiovascular Disease - Review

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

ORCID Icon &
Pages 125-139 | Received 27 Apr 2020, Accepted 23 Oct 2020, Published online: 06 Dec 2020

References

  • Ferreira JP, Kraus S, Mitchell S, et al. World Heart Federation roadmap for heart failure. Glob Heart. 2019;14(3):197–214.
  • Khavjou O, Phelps D, Leib A. Projections of cardiovascular disease prevalence and costs: 2015–2035 [Internet]. Research Triangle Park, NC: RTI International, 2016 [cited 2020 Aug 04]. Available from: https://healthmetrics.heart.org/projections-of-cardiovascular-disease/
  • Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62(16):e147–e239.
  • Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2016;18(8):891–975.
  • Mesquita ET, Lagoeiro Jorge AJ, Rabelo LM, et al. Understanding hospitalization in patients with heart failure. Int J Cardiovasc Sci. 2017;30(1):81–90.
  • Pérez de Isla L, Cañadas V, Contreras L, et al. Diastolic heart failure in the elderly: in-hospital and long-term outcome after the first episode. Int J Cardiol. 2009;134(2):265–270.
  • Dunlay SM, Roger VL, Redfield MM. Epidemiology of heart failure with preserved ejection fraction. Nat Rev Cardiol. 2017;14(10):591–602.
  • Setoguchi S, Stevenson LW, Schneeweiss S. Repeated hospitalizations predict mortality in the community population with heart failure. Am Heart J. 2007;154(2):260–266.
  • Audi G, Korologou A, Koutelekos I, et al. Factors affecting health related quality of life in hospitalized patients with heart failure. Cardiol Res Pract. 2017;2017:4690458.
  • Heidenreich PA, Albert NM, Allen LA, et al. Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. Circ Heart Fail. 2013;6(3):606–619.
  • Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2017;136(6):e137–e161.
  • Lee DS, Gona P, Vasan RS, et al. Relation of disease pathogenesis and risk factors to heart failure with preserved or reduced ejection fraction: insights from the Framingham Heart Study of the National Heart, Lung, and Blood Institute. Circulation. 2009;119(24):3070–3077.
  • Gazewood JD, Turner PL. Heart failure with preserved ejection fraction: diagnosis and management. Am Fam Physician. 2017;96(9):582–588.
  • Paulus WJ, Tschöpe C. A novel paradigm for heart failure with preserved ejection fraction: comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation. J Am Coll Cardiol. 2013;62(4):263–271.
  • Rogers FJ, Gundala T, Ramos JE, et al. Heart failure with preserved ejection fraction. J Am Osteopath Assoc. 2015;115(7):432–442.
  • Sharma K, Kass DA. Heart failure with preserved ejection fraction: mechanisms, clinical features, and therapies. Circ Res. 2014;115(1):79–96.
  •  Huis In 't Veld, de Man FS, van Rossum AC, et al. How to diagnose heart failure with preserved ejection fraction: the value of invasive stress testing. Neth Heart J. 2016;24(4):244–251.
  • Butler J, Fonarow GC, Zile MR, et al. Developing therapies for heart failure with preserved ejection fraction: current state and future directions. JACC Heart Fail. 2014;2(2):97–112.
  • Borlaug BA, Paulus WJ. Heart failure with preserved ejection fraction: pathophysiology, diagnosis, and treatment. Eur Heart J. 2011;32(6):670–679.
  • Fang F, Lee APW, Yu CM. Left atrial function in heart failure with impaired and preserved ejection fraction. Curr Opin Cardiol. 2014;29(5):430–436.
  • Gladden JD, Linke WA, Redfield MM. Heart failure with preserved ejection fraction. Pflugers Arch. 2014;466(6):1037–1053.
  • Zakeri R, Chamberlain AM, Roger VL, et al. Temporal relationship and prognostic significance of atrial fibrillation in heart failure patients with preserved ejection fraction: a community-based study. Circulation. 2013;128(10):1085–1093.
  • Sartipy U, Dahlström U, Fu M, et al. Atrial fibrillation in heart failure with preserved, mid-range, and reduced ejection fraction. JACC Heart Fail. 2017;5(8):565–574.
  • Lam CSP, Santema BT, Voors AA. Atrial fibrillation in heart failure: a common and deadly combination. JACC Heart Fail. 2017;5(8):575–577.
  • Shimizu M, Sugihara N, Shimizu K, et al. Asymmetrical septal hypertrophy in patients with hypertension: a type of hypertensive left ventricular hypertrophy or hypertrophic cardiomyopathy combined with hypertension? Clin Cardiol. 1993;16(1):41–46.
  • Hammond IW, Devereux RB, Alderman MH, et al. Relation of blood pressure and body build to left ventricular mass in normotensive and hypertensive employed adults. J Am Coll Cardiol. 1988;12(4):996–1004.
  • Zuo L, Chuang CC, Hemmelgarn BT, et al. Heart failure with preserved ejection fraction: defining the function of ROS and NO. J Appl Physiol. 2015;119(8):944–951.
  • Westermann D, Lindner D, Kasner M, et al. Cardiac inflammation contributes to changes in the extracellular matrix in patients with heart failure and normal ejection fraction. Circ Heart Fail. 2011;4(1):44–52.
  • McKie PM, Schirger JA, Costello-Boerrigter LC, et al. Impaired natriuretic and renal endocrine response to acute volume expansion in pre-clinical systolic and diastolic dysfunction. J Am Coll Cardiol. 2011;58(20):2095–2103.
  • Pugliese NR, Masi S, Taddei S. The renin-angiotensin-aldosterone system: a crossroad from arterial hypertension to heart failure. Heart Fail Rev. 2020;25(1):31–42.
  • Vergaro G, Aimo A, Prontera C, et al. Sympathetic and renin-angiotensin-aldosterone system activation in heart failure with preserved, mid-range and reduced ejection fraction. Int J Cardiol. 2019;296:91–97.
  • Bakogiannis C, Theofilogiannakos E, Papadopoulos C, et al. A translational approach to the renin-angiotensin-aldosterone system in heart failure. Ann Res Hosp. 2019;3(11). DOI:10.21037/arh.2019.05.01
  • Borlaug BA, Redfield MM. Diastolic and systolic heart failure are distinct phenotypes within the heart failure spectrum. Circulation. 2011;123(18):2006–2014.
  • Baumwol J. “I Need Help” – A mnemonic to aid timely referral in advanced heart failure. J Heart Lung Transplant. 2017;36(5):593–594.
  • Oktay AA, Shah SJ. Diagnosis and management of heart failure with preserved ejection fraction: 10 key lessons. Curr Cardiol Rev. 2015;11(1):42–52.
  • Rutten FH, Gallagher J. What the general practitioner needs to know about their chronic heart failure patient. Card Fail Rev. 2016;2(2):79–84.
  • Ather S, Chan W, Bozkurt B, et al. Impact of non-cardiac comorbidities on morbidity and mortality in a predominantly male population with heart failure and preserved versus reduced ejection fraction. J Am Coll Cardiol. 2012;59(11):998–1005.
  • Herrscher TE, Akre H, Øverland B, et al. High prevalence of sleep apnea in heart failure outpatients: even in patients with preserved systolic function. J Card Fail. 2011;17(5):420–425.
  • Abdullah A, Eigbire G, Salama A, et al. Relation of obstructive sleep apnea to risk of hospitalization in patients with heart failure and preserved ejection fraction from the National Inpatient Sample. Am J Cardiol. 2018;122(4):612–615.
  • Jorge S, Becquemin MH, Delerme S, et al. Cardiac asthma in elderly patients: incidence, clinical presentation and outcome. BMC Cardiovasc Disord. 2007;7:16.
  • Deaton C, Edwards D, Malyon A, et al. The tip of the iceberg: finding patients with heart failure with preserved ejection fraction in primary care. An observational study. BJGP Open. 2018;2(3):bjgpopen18X101606.
  • van Riet EES, Hoes AW, Limburg A, et al. Prevalence of unrecognized heart failure in older persons with shortness of breath on exertion. Eur J Heart Fail. 2014;16(7):772–777.
  • Boonman-de Winter LJ, Rutten FH, Cramer MJ, et al. High prevalence of previously unknown heart failure and left ventricular dysfunction in patients with type 2 diabetes. Diabetologia. 2012;55(8):2154–2162.
  • Upadhya B, Kitzman DW. Heart failure with preserved ejection fraction in older adults. Heart Fail Clin. 2017;13(3):485–502.
  • Iannuzzi-Sucich M, Prestwood KM, Kenny AM. Prevalence of sarcopenia and predictors of skeletal muscle mass in healthy, older men and women. J Gerontol A Biol Sci Med Sci. 2002;57A(12):M772–M777.
  • Franceschi C, Garagnani P, Parini P, et al. Inflammaging: a new immune-metabolic viewpoint for age-related diseases. Nat Rev Endocrinol. 2018;14(10):576–590.
  • DeSouza CA, Shapiro LF, Clevenger CM, et al. Regular aerobic exercise prevents and restores age-related declines in endothelium-dependent vasodilation in healthy men. Circulation. 2000;102(12):1351–1357.
  • Borlaug BA, Redfield MM, Melenovsky V, et al. Longitudinal changes in left ventricular stiffness: A community-based study. Circ Heart Fail. 2013;6(5):944–952.
  • Hawkins NM, Petrie MC, Jhund PS, et al. Heart failure and chronic obstructive pulmonary disease: diagnostic pitfalls and epidemiology. Eur J Heart Fail. 2009;11(2):130–139.
  • Hawkins NM, Virani S, Ceconi C. Heart failure and chronic obstructive pulmonary disease: the challenges facing physicians and health services. Eur Heart J. 2013;34(36):2795–2803.
  • Stone L. Managing the consultation with patients with medically unexplained symptoms: a grounded theory study of supervisors and registrars in general practice. BMC Fam Pract. 2014;15:192.
  • Sexton SM, Loflin R 3rd. The relief of getting a diagnosis. Am Fam Physician. 2009;80(11):1223.
  • Reddy YNV, Carter RE, Obokata M, et al. A simple, evidence-based approach to help guide diagnosis of heart failure with preserved ejection fraction. Circulation. 2018;138(9):861–870.
  • Weber M, Hamm C. Role of B-type natriuretic peptide (BNP) and NT-proBNP in clinical routine. Heart. 2006;92(6):843–849.
  • Nathisuwan S, Talbert RL. A review of vasopeptidase inhibitors: a new modality in the treatment of hypertension and chronic heart failure. Pharmacotherapy. 2002;22(1):27–42.
  • Salah K, Stienen S, Pinto YM, et al. Prognosis and NT-proBNP in heart failure patients with preserved versus reduced ejection fraction. Heart. 2019;105(15):1182–1189.
  • van Veldhuisen DJ, Linssen GCM, Jaarsma T, et al. B-type natriuretic peptide and prognosis in heart failure patients with preserved and reduced ejection fraction. J Am Coll Cardiol. 2013;61(14):1498–1506.
  • Fonarow GC, Peacock WF, Phillips CO, et al. Admission B-type natriuretic peptide levels and in-hospital mortality in acute decompensated heart failure. J Am Coll Cardiol. 2007;49(19):1943–1950.
  • Meijers WC, van der Velde AR, de Boer RA. Biomarkers in heart failure with preserved ejection fraction. Neth Heart J. 2016;24(4):252–258.
  • de Boer RA, Nayor M, deFilippi CR, et al. Association of cardiovascular biomarkers with incident heart failure with preserved and reduced ejection fraction. JAMA Cardiol. 2018;3(3):215–224.
  • Kitzman DW, Little WC, Brubaker PH, et al. Pathophysiological characterization of isolated diastolic heart failure in comparison to systolic heart failure. JAMA. 2002;288(17):2144–2150.
  • O’Donoghue M, Chen A, Baggish AL, et al. The effects of ejection fraction on N-terminal ProBNP and BNP levels in patients with acute CHF: analysis from the ProBNP Investigation of Dyspnea in the Emergency Department (PRIDE) study. J Card Fail. 2005;11(Suppl 5):S9–S14.
  • Mikkelsen KV, Bie P, Møller JE, et al. Neurohormonal activation and diagnostic value of cardiac peptides in patients with suspected mild heart failure. Int J Cardiol. 2006;110(3):324–333.
  • Vanderheyden M, Claeys G, Manoharan G, et al. Head to head comparison of N-terminal pro-B-type natriuretic peptide and B-type natriuretic peptide in patients with/without left ventricular systolic dysfunction. Clin Biochem. 2006;39(6):640–645.
  • Deaton C, Benson J. Time for correct diagnosis and categorisation of heart failure in primary care. Br J Gen Pract. 2016;66(652):554–555.
  • Pieske B, Tschöpe C, de Boer RA, et al. How to diagnose heart failure with preserved ejection fraction: the HFA–PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology. European Heart Journal, 2019;40(40):3297–3317
  • Taylor CJ, Rutten FH, Brouwer JR, et al. Practical guidance on heart failure diagnosis and management in primary care: recent EPCCS recommendations. Br J Gen Pract. 2017;67(660):326–327.
  • Benjamin EJ, Muntner P, Alonso A, et al. Heart disease and stroke statistics – 2019 update: A report from the American Heart Association. Circulation. 2019;139(10):e56–e528.
  • Rodgers GP, Conti JB, Feinstein JA, et al. ACC 2009 survey results and recommendations: addressing the cardiology workforce crisis: a report of the ACC Board of Trustees Workforce Task Force. J Am Coll Cardiol. 2009;54(13):1195–1208.
  • Agency for Healthcare Research and Quality. Coordinating care in the medical neighborhood: critical components and available mechanisms [Internet]. Rockville, MD: Agency for Healthcare Research and Quality; 2011 [cited 2019 Jul 02]. Available from: https://pcmh.ahrq.gov/sites/default/files/attachments/coordinating-care-in-the-medical-neighborhood-white-paper.pdf
  • Yancy CW, Januzzi JL Jr., Allen LA, et al. 2017 ACC expert consensus decision pathway for optimization of heart failure treatment: answers to 10 pivotal issues about heart failure with reduced ejection fraction: a report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. J Am Coll Cardiol. 2018;71(2):201–230.
  • Shakib S, Clark RA. Heart failure pharmacotherapy and supports in the elderly – a short review. Curr Cardiol Rev. 2016;12(3):180–185.
  • McNallan SM, Singh M, Chamberlain AM, et al. Frailty and healthcare utilization among patients with heart failure in the community. JACC Heart Fail. 2013;1(2):135–141.
  • Azad N. Opportunities for care optimization and hospitalization reduction for older persons with heart failure. Clin Med Insights Cardiol. 2019;13:1179546819841597.
  • Upadhya B, Pisani B, Kitzman DW. Evolution of a geriatric syndrome: pathophysiology and treatment of heart failure with preserved ejection fraction. J Am Geriatr Soc. 2017;65(11):2431–2440.
  • Adamson PB, Abraham WT, Bourge RC, et al. Wireless pulmonary artery pressure monitoring guides management to reduce decompensation in heart failure with preserved ejection fraction. Circ Heart Fail. 2014;7(6):935–944.
  • Abraham WT, Adamson PB, Bourge RC, et al. Wireless pulmonary artery haemodynamic monitoring in chronic heart failure: a randomised controlled trial. Lancet. 2011;377(9766):658–666.
  • Yusuf S, Pfeffer MA, Swedberg K, et al. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-Preserved Trial. Lancet. 2003;362(9386):777–781.
  • Liu G, Zheng XX, Xu YL, et al. Meta-analysis of the effect of statins on mortality in patients with preserved ejection fraction. Am J Cardiol. 2014;113(7):1198–1204.
  • Pitt B, Pfeffer MA, Assmann SF, et al. Spironolactone for heart failure with preserved ejection fraction. N Engl J Med. 2014;370(15):1383–1392.
  • Setaro JF, Zaret BL, Schulman DS, et al. Usefulness of verapamil for congestive heart failure associated with abnormal left ventricular diastolic filling and normal left ventricular systolic performance. Am J Cardiol. 1990;66(12):981–986.
  • Hung MJ, Cherng WJ, Kuo LT, et al. Effect of verapamil in elderly patients with left ventricular diastolic dysfunction as a cause of congestive heart failure. Int J Clin Pract. 2002;56(1):57–62.
  • Patel K, Fonarow GC, Ahmed M, et al. Calcium channel blockers and outcomes in older patients with heart failure and preserved ejection fraction. Circ Heart Fail. 2014;7(6):945–952.
  • Jhund PS, Claggett B, Packer M, et al. Independence of the blood pressure lowering effect and efficacy of the angiotensin receptor neprilysin inhibitor, LCZ696, in patients with heart failure with preserved ejection fraction: an analysis of the PARAMOUNT trial. Eur J Heart Fail. 2014;16(6):671–677.
  • Voors AA, Gori M, Liu LC, et al. Renal effects of the angiotensin receptor neprilysin inhibitor LCZ696 in patients with heart failure and preserved ejection fraction. Eur J Heart Fail. 2015;17(5):510–517.
  • Solomon SD, Rizkala AR, Lefkowitz MP, et al. Baseline characteristics of patients with heart failure and preserved ejection fraction in the PARAGON-HF trial. Circ Heart Fail. 2018;11(7):e004962.
  • Solomon SD, Rizkala AR, Gong J, et al. Angiotensin receptor neprilysin inhibition in heart failure with preserved ejection fraction: rationale and design of the PARAGON-HF trial. JACC Heart Fail. 2017;5(7):471–482.
  • Solomon SD, JJV M, Anand IS, et al. Angiotensin-neprilysin inhibition in heart failure with preserved ejection fraction. N Engl J Med. 2019;381(17):1609–1620.
  • Wiviott SD, Raz I, Bonaca MP, et al. Dapagliflozin and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2019;380(4):347–357.
  • Solomon SD, Zile M, Pieske B, et al. The angiotensin receptor neprilysin inhibitor LCZ696 in heart failure with preserved ejection fraction: a phase 2 double-blind randomised controlled trial. Lancet. 2012;380(9851):1387–1395.
  • Anker SD, Butler J, Filippatos GS, et al. Evaluation of the effects of sodium-glucose co-transporter 2 inhibition with empagliflozin on morbidity and mortality in patients with chronic heart failure and a preserved ejection fraction: rationale for and design of the EMPEROR-Preserved Trial. Eur J Heart Fail. 2019;21(10):1279–1287.
  • Vardeny O, Miller R, Solomon SD. Combined neprilysin and renin-angiotensin system inhibition for the treatment of heart failure. JACC Heart Fail. 2014;2(6):663–670.
  • Martinez-Rumayor A, Richards AM, Burnett JC, et al. Biology of the natriuretic peptides. Am J Cardiol. 2008;101(Suppl 3):S3–S8.
  • McMurray JJV, Jackson AM, Lam CSP, et al. Effects of sacubitril-valsartan versus valsartan in women compared with men with heart failure and preserved ejection fraction: insights from PARAGON-HF. Circulation. 2020;141(5):338–351.
  • Solomon SD, Vaduganathan M, Claggett BL, et al. Sacubitril/valsartan across the spectrum of ejection fraction in heart failure. Circulation. 2020;141(5):352–361.
  • Kato ET, Silverman MG, Mosenzon O, et al. Effect of dapagliflozin on heart failure and mortality in type 2 diabetes mellitus. Circulation. 2019;139(22):2528–2536.
  • Shah SJ, Feldman T, Ricciardi MJ, et al. One-year safety and clinical outcomes of a transcatheter interatrial shunt device for the treatment of heart failure with preserved ejection fraction in the Reduce Elevated Left Atrial Pressure in Patients with Heart Failure (REDUCE LAP-HF I) trial: a randomized clinical trial. JAMA Cardiol. 2018;3(10):968–977.
  • Alves AJ, Ribeiro F, Goldhammer E, et al. Exercise training improves diastolic function in heart failure patients. Med Sci Sports Exerc. 2012;44(5):776–785.
  • Edelmann F, Gelbrich G, Düngen HD, et al. Exercise training improves exercise capacity and diastolic function in patients with heart failure with preserved ejection fraction: results of the Ex-DHF (Exercise training in Diastolic Heart Failure) pilot study. J Am Coll Cardiol. 2011;58(17):1780–1791.
  • Haykowsky MJ, Brubaker PH, Stewart KP, et al. Effect of endurance training on the determinants of peak exercise oxygen consumption in elderly patients with stable compensated heart failure and preserved ejection fraction. J Am Coll Cardiol. 2012;60(2):120–128.
  • Smart NA, Haluska B, Jeffriess L, et al. Exercise training in heart failure with preserved systolic function: a randomized controlled trial of the effects on cardiac function and functional capacity. Congest Heart Fail. 2012;18(6):295–301.
  • Kitzman DW, Brubaker P, Morgan T, et al. Effect of caloric restriction or aerobic exercise training on peak oxygen consumption and quality of life in obese older patients with heart failure with preserved ejection fraction: a randomized clinical trial. JAMA. 2016;315(1):36–46.
  • Hummel SL, Seymour EM, Brook RD, et al. Low-sodium dietary approaches to stop hypertension diet reduces blood pressure, arterial stiffness, and oxidative stress in hypertensive heart failure with preserved ejection fraction. Hypertension. 2012;60(5):1200–1206.
  • Zhao W, Katzmarzyk PT, Horswell R, et al. HbA1c and heart failure risk among diabetic patients. J Clin Endocrinol Metab. 2014;99(2):E263–E267.
  • Jorge AJL, Rosa MLG, da Silva Correia DM, et al. Evaluation of quality of life in patients with and without heart failure in primary care. Arq Bras Cardiol. 2017;109(3):248–252.