Reshaping Treatment of Heart Failure with Preserved Ejection Fraction

Area of Science:

• Cardiology
• Internal Medicine
• Pharmacology

Background:

• Heart failure with preserved ejection fraction (HFpEF) affects about 50% of heart failure patients.
• HFpEF treatment has long been an unmet clinical need due to classification complexities and diverse underlying pathologies.
• Previous assumptions about absent neurohormonal overactivity in HFpEF patients with higher ejection fractions have been challenged.

Purpose of the Study:

• To re-evaluate the treatment strategies for HFpEF.
• To highlight the efficacy of neurohormonal and SGLT2 inhibitors across a wider range of left ventricular ejection fraction (LVEF).
• To advocate for the inclusion of hypertensive HFpEF patients in treatment protocols previously limited to reduced ejection fraction.

Main Methods:

• Analysis of current data and clinical trial outcomes in HFpEF.
• Review of HF classification criteria and LVEF normal ranges.
• Examination of HFpEF phenotypes, focusing on hypertensive heart disease.

Main Results:

• Current HFpEF trials predominantly included patients with hypertension and excluded valvular heart disease and hypertrophic cardiomyopathy.
• Neurohormonal and SGLT2 inhibitors demonstrated efficacy in HF patients across a broad spectrum of LVEF.
• The efficacy of these treatments was observed even in HFpEF patients with higher LVEF values.

Conclusions:

• Restricting life-saving treatments like neurohormonal and SGLT2 inhibitors to only HF patients with reduced LVEF is no longer justified.
• Hypertensive HFpEF represents a significant and common phenotype that warrants consideration for these advanced therapies.
• Treatment guidelines should be updated to include HFpEF patients, especially those with hypertension, for neurohormonal and SGLT2 inhibitor therapies.