From the Guidelines
The most effective treatment for Heart Failure with preserved Ejection Fraction (HFpEF) is supervised exercise training, which has been shown to improve symptoms, exercise capacity, and quality of life, as demonstrated in the 2023 American Heart Association and American College of Cardiology scientific statement 1. This approach is supported by the latest evidence, which highlights the benefits of exercise-based interventions in improving outcomes for patients with HFpEF. Key aspects of HFpEF treatment include:
- Symptom management using diuretics like furosemide or hydrochlorothiazide to reduce fluid overload and relieve symptoms such as dyspnea and edema
- Blood pressure control with ACE inhibitors or ARBs, as recommended in the 2024 ESC guidelines for the management of elevated blood pressure and hypertension 1
- Use of SGLT2 inhibitors like empagliflozin or dapagliflozin to reduce hospitalizations and cardiovascular death, as demonstrated in recent clinical trials 1
- Targeted treatments for specific comorbidities, such as strict glycemic control for diabetes, weight loss for obesity, and CPAP for sleep apnea
- Exercise training, which has been shown to improve exercise capacity and quality of life, and is recommended as a first-line treatment for HFpEF 1. It is essential to prioritize supervised exercise training as the primary treatment approach for HFpEF, given its proven benefits in improving symptoms, exercise capacity, and quality of life, as well as its potential to address the underlying pathophysiological mechanisms of the disease 1.
From the Research
HFpEF Treatment Overview
- HFpEF treatment is limited, with few effective options currently identified 2, 3
- Current treatment strategies for HFpEF include:
- Decongestion by diuretics 2
- Promotion of a healthy active lifestyle 2, 4
- Management of comorbidities 2, 3, 5
- Sodium-glucose cotransporter 2 inhibitors to reduce the risk of composite cardiovascular events 4
- Renin-angiotensin-aldosterone blockers and angiotensin-neprilysin inhibitors to reduce HF hospitalisations 4
- Comprehensive management of HFpEF includes exercise and treatment of risk factors and comorbidities 4, 5
Challenges in HFpEF Treatment
- HFpEF is a heterogeneous syndrome with a lack of effective therapeutic strategies 3, 6
- Differentiating HFpEF from other causes of dyspnoea may require advanced diagnostic methods 4
- Medication classes that are efficacious in HF with reduced ejection fraction have been less effective in HFpEF 4
- The burden of non-cardiac comorbidities increases as LVEF increases, making treatment more complex 4