From the Guidelines
The best treatment for diastolic dysfunction (heart failure with preserved ejection fraction) is primarily focused on managing symptoms and addressing underlying causes, with diuretics being the mainstay of treatment to control sodium and water retention and relieve breathlessness and oedema. The treatment approach should prioritize controlling hypertension and myocardial ischemia, as well as managing ventricular rate in patients with atrial fibrillation (AF) 1. Key considerations in the management of diastolic dysfunction include:
- The use of diuretics to alleviate symptoms of fluid overload
- Adequate control of hypertension, which is crucial in reducing the strain on the heart
- Management of myocardial ischemia to prevent further cardiac damage
- Ventricular rate control in patients with AF, which can be achieved through the use of rate-limiting calcium-channel blockers (CCBs) like verapamil or beta-blockers 1
- Avoidance of drugs that are harmful in heart failure with reduced ejection fraction (HF-REF), with the exception of CCBs, which may be beneficial in certain cases 1 It's essential to note that, as of the latest guidelines 1, no treatment has been convincingly shown to reduce morbidity and mortality in patients with HF-PEF, making symptom management and treatment of underlying conditions the primary focus of therapy. Lifestyle modifications, such as sodium restriction, regular physical activity, weight management, and smoking cessation, are also crucial in managing diastolic dysfunction and should be implemented alongside pharmacological treatment 1.
From the FDA Drug Label
Sacubitril and valsartan tablets are indicated to reduce the risk of cardiovascular death and hospitalization for heart failure in adult patients with chronic heart failure. Benefits are most clearly evident in patients with left ventricular ejection fraction (LVEF) below normal.
The best treatment for diastolic dysfunction (heart failure with preserved ejection fraction) is not directly stated in the provided drug labels. The labels indicate that sacubitril/valsartan is most beneficial for patients with left ventricular ejection fraction (LVEF) below normal, which is not the same as heart failure with preserved ejection fraction.
- Key point: The labels do not provide information on the treatment of heart failure with preserved ejection fraction.
- Main idea: Sacubitril/valsartan is indicated for heart failure with reduced ejection fraction, not preserved ejection fraction 2, 2.
From the Research
Treatment Options for Diastolic Dysfunction
The treatment of diastolic dysfunction, also known as heart failure with preserved ejection fraction, involves a combination of pharmacologic and non-pharmacologic interventions. Some of the key treatment options include:
- Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, which have been shown to improve measures of diastolic function 3, 4, 5, 6
- Beta-blockers, which can help prevent tachycardia and prolong left ventricular diastolic filling time 7, 4, 5, 6
- Calcium channel blockers, which can help reduce blood pressure and improve diastolic function 7, 6
- Diuretics, which are used to prevent pulmonary congestion and reduce symptoms of heart failure 4, 5, 6
- Non-dihydropyridine calcium channel blockers, which can help reduce blood pressure and improve diastolic function 6
Goals of Treatment
The goals of treatment for diastolic dysfunction include:
- Relieving symptoms of heart failure
- Preventing exacerbations of heart failure
- Reducing mortality
- Improving quality of life
- Stopping the progression of the disease 3, 6
Underlying Disease Treatment
Treatment of the underlying disease, such as hypertension, coronary artery disease, and diabetes mellitus, is also crucial in managing diastolic dysfunction 7, 6.
Ongoing Research
Ongoing research, such as the Trial Of Preserved Cardiac function heart failure with an Aldosterone anTagonist (TOPCAT) study, is aimed at evaluating the effect of spironolactone on cardiovascular mortality, aborted cardiac arrest, or hospitalization for diastolic heart failure 3.