From the Guidelines
The best management of Heart Failure with preserved Ejection Fraction (HFpEF) involves a comprehensive approach targeting symptom relief, comorbidity management, and prevention of hospitalizations, with SGLT2 inhibitors such as empagliflozin or dapagliflozin being recommended to reduce hospitalizations and cardiovascular death, as supported by the most recent guidelines 1.
Key Components of Management
- Treatment should begin with diuretics like furosemide (20-80mg daily) or hydrochlorothiazide (12.5-50mg daily) to manage fluid overload and relieve symptoms.
- SGLT2 inhibitors such as empagliflozin (10mg daily) or dapagliflozin (10mg daily) are recommended as they reduce hospitalizations and cardiovascular death, as shown in recent trials 1.
- For patients with elevated blood pressure, ACE inhibitors (like lisinopril 5-40mg daily) or ARBs (such as valsartan 40-320mg daily) should be considered, as recommended by the 2024 ESC guidelines for the management of chronic coronary syndromes 1.
- Beta-blockers (metoprolol succinate 25-200mg daily or carvedilol 3.125-25mg twice daily) may help patients with concurrent coronary artery disease or atrial fibrillation.
Lifestyle Modifications and Comorbidity Management
- Aggressive management of comorbidities is essential, including hypertension, diabetes, obesity, coronary artery disease, and atrial fibrillation.
- Lifestyle modifications are crucial, including sodium restriction (<2g daily), regular physical activity, weight management, and smoking cessation, as emphasized in the 2022 AHA/ACC/HFSA guideline for the management of heart failure 1.
- Regular monitoring of symptoms, fluid status, electrolytes, and renal function is necessary to optimize treatment and prevent decompensation.
Exercise and Device-Based Therapies
- Supervised exercise training has been shown to improve symptoms, exercise capacity, and quality of life in patients with HFpEF, as highlighted in a scientific statement from the American Heart Association and American College of Cardiology 1.
- Device-based solutions, such as wireless pulmonary artery pressure monitoring devices, may also be beneficial in reducing hospitalizations and improving outcomes in patients with HFpEF.
From the Research
Management of Heart Failure with Preserved Ejection Fraction (HFpEF)
The management of HFpEF is challenging due to the lack of effective pharmacological targets to improve outcomes. However, several strategies can be employed to manage the condition:
- Control of risk factors, such as hypertension, diabetes, and obesity, is crucial in managing HFpEF 2, 3, 4, 5, 6
- Symptomatic relief of congestion with diuretics is a common approach 3, 4, 6
- Promotion of a healthy active lifestyle, including diet and exercise, can improve functional capacity and quality of life 2, 5
- Management of comorbidities, such as myocardial ischemia and atrial fibrillation, is also important 3, 6
Pharmacological Therapies
Several pharmacological therapies have been investigated for the management of HFpEF, including:
- Renin-angiotensin-aldosterone inhibitors 3
- Calcium channel blockers (CCB) 3
- Beta-blockers 3
- Soluble guanylate cyclase stimulators 3
- Inorganic nitrates 3
- Angiotensin receptor neprilysin inhibitor LCZ 696 3
- SGLT2 inhibitors 3
Device-Based Therapies
Several device-based therapies have also been investigated for the management of HFpEF, including:
- CardioMEMS 3
- Interatrial septal devices (IASD) 3
- Cardiac contractility modulation (CCM) 3
- Renal denervation 3
- Baroreflex activation therapy (BAT) 3
Future Directions
Improved phenotyping of subgroups within the overall HFpEF population may enhance individualization of treatment 5. Novel therapies, such as anti-inflammatory drugs, mitochondrial-targeted antioxidants, and microRNA-guided interventions, are also being investigated 3.