Device Therapy for Heart Failure With Preserved Ejection Fraction: The Problem, the Mechanism, the Device, the Trial

Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome of epidemic proportions associated with elevation of left sided heart pressures despite a left ventricular ejection fraction (LVEF) of > 50%. 1 Patients with HFpEF have signs and symptoms of heart failure (HF) similar to patients with HF with reduced ejection fraction (HFrEF) and account for slightly greater than half of all patients with HF. 2 Prognosis for both HFpEF and HFrEF are similar and are markedly worse than those of the general population. 3 Unlike HFrEF, which has had several evidenced based therapies for decades, HFpEF still has limited approved treatment options, and uptake for many patients is poor. However, there are several innovative devices that are being evaluated in clinical trials for the treatment of HFpEF, most notably left atrial decompression devices. A key driver for the success of these therapies will be defining the appropriate patient population to study within the broader HFpEF population.