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Heart Failure with Preserved Ejection Fraction: Diagnosis and Management.
John D Gazewood1, Patrick L Turner2
1University of Virginia Health System, Charlottesville, VA, USA.
American Family Physician
|November 3, 2017
Summary
Heart failure with preserved ejection fraction (HFpEF), or diastolic heart failure, affects nearly half of US heart failure cases. Management focuses on symptom relief with diuretics and treating comorbidities like hypertension and atrial fibrillation.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Heart failure with preserved ejection fraction (HFpEF), also known as diastolic heart failure, accounts for nearly 50% of heart failure cases in the US.
- It disproportionately affects older individuals and women, stemming from impaired ventricular relaxation and compliance, reducing stroke volume and cardiac output.
Purpose of the Study:
- To outline the diagnostic criteria and management strategies for heart failure with preserved ejection fraction.
- To highlight the importance of recognizing HFpEF symptoms and signs for timely diagnosis and intervention.
Main Methods:
- Diagnosis is suspected based on typical heart failure symptoms and signs, confirmed by echocardiography showing normal ejection fraction with diastolic dysfunction.
- Natriuretic peptide measurement aids in ambulatory evaluation.
- Review of multiple clinical trials on treatment efficacy.
Main Results:
- Medications have limited efficacy, with diuretics being the primary treatment for congestive symptoms.
- Management involves treating comorbidities such as hypertension, atrial fibrillation (rate control and anticoagulation), and considering revascularization for coronary artery disease.
- Multidisciplinary team care and exercise may offer benefits.
Conclusions:
- HFpEF prognosis is similar to heart failure with reduced ejection fraction, influenced by factors like brain natriuretic peptide levels, age, prior myocardial infarction, and diastolic function.
- Effective management relies on symptom control, comorbidity treatment, and supportive care strategies.
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