Heart Failure: Heart Failure With Preserved Ejection Fraction

Area of Science:

• Cardiology
• Internal Medicine

Background:

• Heart failure (HF) presents a significant public health challenge in the US, with high incidence and prevalence.
• Increasing age is a primary nonmodifiable risk factor for HF development.
• Modifiable risk factors including hypertension, diabetes, and ischemic heart disease require management to mitigate HF morbidity and mortality.

Purpose of the Study:

• To update understanding of heart failure classification and management strategies.
• To highlight the importance of current terminology, moving away from outdated terms like 'congestive heart failure'.
• To define current approaches to managing HF with preserved ejection fraction (HFpEF).

Main Methods:

• Classification of left-sided HF based on ejection fraction (EF).
• Definition of HF with preserved EF (HFpEF) for EF ≥ 50%.
• Definition of HF with reduced EF (HFrEF) for EF ≤ 40%.

Main Results:

• HFpEF management priorities include symptom control and managing comorbid conditions.
• Key management strategies for HFpEF involve fluid overload avoidance, optimized blood pressure control, and atrial fibrillation management.
• HFpEF diagnosis carries a substantial 5-year mortality rate (22%-65%), with cardiovascular causes accounting for the majority of deaths (51%-60%).

Conclusions:

• Current HF classification relies on EF, distinguishing HFpEF from HFrEF.
• Effective HFpEF management necessitates a focus on symptom relief and addressing underlying health issues.
• The high mortality associated with HFpEF underscores the need for continued research and improved therapeutic strategies.