What is the Guideline-Directed Medical Therapy (GDMT) for Heart Failure with preserved Ejection Fraction (HFpEF)?

From the Guidelines

Guideline-Directed Medical Therapy (GDMT) for Heart Failure with preserved Ejection Fraction (HFpEF) should prioritize symptom management, treating underlying conditions, and controlling blood pressure, with a focus on using SGLT2 inhibitors, diuretics, and other medications as indicated by the most recent clinical practice guidelines.

Key Components of GDMT for HFpEF

• SGLT2 inhibitors, such as empagliflozin or dapagliflozin, have shown benefits in reducing composite cardiovascular death or HF hospitalizations 1.
• Diuretics, particularly loop diuretics like furosemide or torsemide, are crucial for managing volume overload and symptoms like dyspnea and edema.
• Blood pressure control is essential, with ACE inhibitors, ARBs, or ARNIs recommended for patients with hypertension.
• For patients with atrial fibrillation, rate control with beta-blockers or calcium channel blockers, along with anticoagulation therapy, is important.
• Mineralocorticoid receptor antagonists like spironolactone may benefit selected patients.

Considerations for GDMT in HFpEF

• Treatment should be individualized based on comorbidities such as diabetes, hypertension, and coronary artery disease.
• The pathophysiology of HFpEF involves diastolic dysfunction, impaired ventricular filling, and increased myocardial stiffness, which is why therapy targets volume status, blood pressure, and comorbid conditions rather than directly improving contractility.
• Recent clinical practice guidelines, such as those reviewed in the 2024 systematic review 1, should guide the management of HFpEF, emphasizing the importance of symptom improvement, reducing congestion, and treating cardiovascular and non-cardiovascular comorbidities.

Prioritizing Morbidity, Mortality, and Quality of Life

• The choice of GDMT for HFpEF should prioritize reducing morbidity, mortality, and improving quality of life, with a focus on the most recent and highest-quality evidence available 1.
• Given the lack of disease-modifying therapies for HFpEF in the past, the emergence of SGLT2 inhibitors as a beneficial treatment option is significant and should be considered in the context of overall patient management.

From the Research

Guideline-Directed Medical Therapy (GDMT) for Heart Failure with Preserved Ejection Fraction (HFpEF)

• There are no research papers provided that directly address the Guideline-Directed Medical Therapy (GDMT) for Heart Failure with preserved Ejection Fraction (HFpEF) 2, 3, 4, 5, 6.
• The provided studies focus on GDMT for Heart Failure with reduced Ejection Fraction (HFrEF), discussing the importance of renin-angiotensin system inhibitors, beta-blockers, mineralocorticoid receptor antagonists, and sodium-glucose transporter 2 inhibitors in improving clinical outcomes for HFrEF patients.
• The studies highlight the underutilization of GDMT in HFrEF patients, emphasizing the need for increased awareness and implementation of these therapies to improve patient outcomes.
• While the studies do not directly address HFpEF, they provide insight into the importance of GDMT in heart failure treatment, which may be relevant to understanding the approach to HFpEF treatment.
• Further research is needed to determine the specific GDMT recommendations for HFpEF patients, as the provided studies do not offer guidance on this topic.