Device-based therapies for heart failure with preserved ejection fraction

Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome with various causes and a pathophysiology that leads to diverse spectrum of phenotypes. In contrast to a wide range of established treatments for heart failure with reduced ejection fraction (HFrEF), effective medical treatment options for HFpEF are relatively limited with excessively high residual risk of morbidity and mortality. Device-based therapies have emerged as a promising strategy to improve outcomes in patients with HFpEF. Herein, we present data on devices in HFpEF targeting various unique mechanisms including structural inventions, autonomic modulation, and electrophysiologic modulation as well as remote monitoring devices. While early studies of these therapeutic devices have not definitively demonstrated clinical benefits in HFpEF, growing evidence suggests potential benefits in select patient populations for some of these emerging technologies.