Heart Failure With Preserved Ejection Fraction in the Elderly Population: Basic Mechanisms and Clinical...

Area of Science:

• Cardiology
• Geriatrics
• Internal Medicine

Background:

• Heart failure with preserved ejection fraction (HFpEF) presents with heart failure symptoms despite normal ejection fraction.
• HFpEF is notably prevalent in the elderly population, necessitating a focused understanding of age-related aspects.
• Existing definitions for HFpEF have evolved, with current guidelines using an ejection fraction cutoff of 50%.

Purpose of the Study:

• To review the existing literature on HFpEF specifically in elderly patients.
• To examine the age-related evidence, distinct clinical features, and underlying mechanisms of HFpEF in older adults.
• To identify knowledge gaps and future research directions for improving HFpEF outcomes in the elderly.

Main Methods:

• Narrative review of available literature on HFpEF in elderly patients.
• Analysis of epidemiological data, clinical phenotypes, frailty, biomarkers, and medical therapies.
• Discussion of fundamental pathophysiological mechanisms including cellular senescence, fibrosis, inflammation, and metabolic changes.

Main Results:

• HFpEF exhibits specific clinical phenotypes in the elderly, influenced by factors like frailty.
• A range of medical therapies, including SGLT2 inhibitors and ARNI, are discussed for their role in managing HFpEF.
• Multiple underlying mechanisms contribute to age-related HFpEF risk, such as cellular senescence, inflammation, and insulin resistance.

Conclusions:

• Understanding the age-specific clinical manifestations and mechanisms of HFpEF is crucial for the elderly.
• Targeting these mechanisms offers potential for novel diagnostic and therapeutic strategies.
• Improved approaches are needed to enhance outcomes for this vulnerable elderly population with HFpEF.