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Current Management of Heart Failure with Preserved Ejection Fraction.
Akash H Patel1, Balaji Natarajan2,3, Ramdas G Pai2,3
1Department of Internal Medicine, University of California Irvine Medical Center, Orange, California.
Summary
Heart failure with preserved ejection fraction (HFpEF) affects many globally and lacks targeted treatments. This review examines historical and future trials, highlighting a shift towards managing HFpEF as a systemic inflammatory condition.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Trials
Background:
- Heart failure with preserved ejection fraction (HFpEF) accounts for nearly half of all heart failure cases worldwide.
- HFpEF is associated with significant morbidity and mortality, often coexisting with vascular disease.
- The heterogeneity of HFpEF has historically limited the success of targeted pharmacotherapies for survival benefits.
Purpose of the Study:
- To provide a comprehensive historical review of randomized controlled trials (RCTs) in HFpEF management.
- To explore the evolving understanding of HFpEF pathophysiology, including inflammatory, neurohormonal, and interstitial processes.
- To discuss the phenotypic approach to HFpEF treatment and its link to systemic disease management.
Main Methods:
- Review of past, present, and future randomized controlled trials focused on HFpEF.
- Analysis of the paradigm shift in understanding HFpEF pathophysiology.
- Examination of comorbidities associated with HFpEF and ongoing clinical trials.
Main Results:
- Targeted pharmacotherapy has not yet demonstrated survival benefits in HFpEF.
- A phenotypic approach, treating HFpEF as a systemic disease, is gaining popularity.
- Understanding the links between HFpEF and its comorbidities is crucial for effective management.
Conclusions:
- Effective management of HFpEF requires recognizing its complexity and systemic nature.
- Future research and clinical trials are essential to uncover therapeutic strategies for HFpEF.
- A phenotypic approach may offer a more personalized and effective treatment paradigm for HFpEF patients.
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