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Therapy for heart failure with preserved ejection fraction: current status, unique challenges, and future directions
Bharathi Upadhya1, Mark J Haykowsky2, Dalane W Kitzman3
1Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1045, USA.
Heart Failure Reviews
|June 8, 2018
Summary
Heart failure with preserved ejection fraction (HFpEF) is common and serious, especially in older women. Current treatments are uncertain, unlike those for heart failure with reduced ejection fraction (HFrEF).
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Heart failure with preserved ejection fraction (HFpEF) is the predominant form of heart failure, particularly among elderly women.
- HFpEF is associated with significant morbidity, including exercise intolerance, reduced quality of life, frequent hospitalizations, and decreased survival, comparable to heart failure with reduced ejection fraction (HFrEF).
Purpose of the Study:
- To provide an overview of the current management of HFpEF.
- To examine evolving data that may elucidate the pathophysiology of HFpEF and explain the paradox of negative therapeutic trials.
- To offer a roadmap for future research and clinical trials in HFpEF.
Main Methods:
- Review of current literature and clinical trial data on HFpEF.
- Analysis of the contrasting therapeutic landscapes between HFpEF and HFrEF.
- Examination of emerging insights into HFpEF pathophysiology.
Main Results:
- Despite its prevalence and adverse outcomes, the pathophysiology of HFpEF remains incompletely understood.
- Most therapeutic trials for HFpEF have yielded negative results, unlike the numerous positive trials for HFrEF.
- Evolving data suggest potential pathways to overcome challenges and inform future trial designs.
Conclusions:
- Optimal therapy for HFpEF remains uncertain, highlighting a critical unmet need.
- Understanding HFpEF pathophysiology is crucial for developing effective treatments.
- New trials are underway, guided by emerging insights, to test novel therapeutic approaches for HFpEF.
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