From the Guidelines
Treatment of diastolic heart failure, also known as heart failure with preserved ejection fraction (HFpEF), should focus on symptom management and addressing underlying conditions, with diuretics, SGLT2 inhibitors, and blood pressure control being key components of therapy, as recommended by the 2022 AHA/ACC/HFSA guideline 1. The cornerstone of treatment includes diuretics like furosemide or hydrochlorothiazide to reduce fluid overload and relieve symptoms of congestion.
- Blood pressure control is essential, with ACE inhibitors or ARBs recommended for hypertensive patients.
- SGLT2 inhibitors like empagliflozin or dapagliflozin have shown promising results in reducing hospitalizations, and their use is supported by the 2022 AHA/ACC/HFSA guideline 1.
- Lifestyle modifications are crucial, including sodium restriction, regular physical activity, and weight management.
- Treatment of comorbidities such as diabetes, atrial fibrillation, and coronary artery disease is important for comprehensive management. Unlike systolic heart failure, diastolic heart failure lacks specific therapies that significantly improve mortality, making symptom control and addressing underlying conditions the primary focus of treatment, as noted in the 2022 review on optimal background pharmacological therapy for heart failure patients 1. The use of ARNi, MRA, and ARB may be considered in certain patients with HFpEF, as recommended by the 2022 AHA/ACC/HFSA guideline 1, but the evidence for these therapies is not as strong as for diuretics and SGLT2 inhibitors. Overall, the treatment of diastolic heart failure should be individualized and based on the patient's specific needs and underlying conditions, with a focus on symptom management and improving quality of life, as emphasized in the 2013 ACCF/AHA guideline for the management of heart failure 1.
From the Research
Treatment Guidance for Diastolic Heart Failure
- The treatment of diastolic heart failure is aimed at stopping the progression of the disease, relieving its symptoms, eliminating exacerbations, and reducing mortality 2.
- The management should include antihypertensive treatment, maintenance of the sinus rhythm, prevention of tachycardia, venous pressure reduction, prevention of myocardial ischemia, and prevention of diabetes mellitus 2.
- The European Society of Cardiology specifies the type of therapy in diastolic heart failure based on:
- Angiotensin converting enzyme inhibitors
- Angiotensin receptor blockers
- Beta-blockers
- Non-dihydropyridine calcium channel blockers
- Diuretics 2
- Beta-blockers are effective in the prevention of heart failure in the post-MI period and as first-line agents in the treatment of young/middle-aged hypertension and as second-line agents in the treatment of elderly systolic hypertension 3.
- The choice of beta-blocker is important, as benefit is not a class-effect, and the possession of intrinsic sympathomimetic activity (ISA) markedly diminishes efficacy 3.
- The current therapeutic modalities for diastolic heart failure are aimed more towards associated conditions, such as hypertension, rather than the underlying pathophysiology 4.
- Aggressive management of contributing factors is the key to the treatment of diastolic heart failure, and the understanding of the phenotypic heterogeneity and multifactorial pathophysiology of diastolic heart failure may lead to novel therapeutic targets in the future 5.
- Both nonpharmacologic and pharmacologic management are effective and necessary to control the clinical signs and symptoms of diastolic heart failure and improve overall quality of life 6.