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How Would You Manage This Patient With Heart Failure With Preserved Ejection Fraction? : Grand Rounds Discussion From
Gerald W Smetana1, Jennifer E Ho1, Ariela R Orkaby2
1Beth Israel Deaconess Medical Center, Boston, Massachusetts (G.W.S., J.E.H., E.E.R.).
Annals of Internal Medicine
|December 11, 2023
Summary
Heart failure with preserved ejection fraction (HFpEF) is increasingly common and challenging to diagnose. New guidelines offer expanded treatment options beyond diuretics for this predominant heart failure subtype.
Area of Science:
- Cardiology
- Geriatrics
- Heart Failure Research
Background:
- Heart failure with preserved ejection fraction (HFpEF) is a growing clinical challenge, now more prevalent than heart failure with reduced ejection fraction (HFrEF).
- HFpEF diagnosis is complex due to overlapping symptoms with other conditions and often subtle physical findings, leading to potential underdiagnosis.
- Risk factors for HFpEF include an aging population, obesity, and cardiometabolic diseases.
Observation:
- The 2022 American College of Cardiology/American Heart Association/Heart Failure Society of America guidelines updated HFpEF management, with diuretics remaining a Class 1 recommendation.
- New recommendations include broader consideration of sodium-glucose cotransporter-2 inhibitors (SGLT2i) as Class 2a and angiotensin receptor-neprilysin inhibitors as Class 2b.
- A 2023 expert consensus pathway offers sex- and patient-specific treatment strategies for HFpEF.
Findings:
- Cardiologists and geriatricians are discussing practical approaches to HFpEF diagnosis and management.
- Expert opinions highlight applying current guidelines to individual patient profiles.
- The discussion emphasizes personalized treatment strategies based on ejection fraction, congestion, and SGLT2i candidacy.
Implications:
- Updated guidelines and expert consensus pathways aim to improve HFpEF diagnosis and management.
- Personalized treatment approaches may enhance outcomes for patients with HFpEF.
- Further research and clinical application of new therapies are crucial for addressing the rising prevalence of HFpEF.
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