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Published on: March 29, 2024
Heart failure with preserved ejection fraction: updated diagnostic and therapeutic strategies. SEMI consensus
José María Fernández Rodríguez1, María Belén Alonso-Ortíz2, Jesús Casado Cerrada3
1UMIPIC, Internal Medicine Clinical Management Unit, Hospital Universitario Central de Asturias, Oviedo, Spain.
Insights
Heart failure with preserved ejection fraction (HF-pEF) is common in older adults and complex to diagnose. Recent clinical trials show new treatments like SGLT2 inhibitors significantly improve outcomes, necessitating updated management guidelines.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Heart failure (HF) presents significant morbidity and mortality.
- HF with preserved left ventricular ejection fraction (HF-pEF) is the most common HF type, particularly in the elderly, often with comorbidities.
- Diagnosing HF-pEF is complex, requiring differentiation from secondary forms.
Purpose of the Study:
- To review the evolving treatment landscape for HF-pEF.
- To highlight recent clinical trial evidence impacting HF-pEF management.
- To emphasize the need for updated clinical recommendations.
Main Methods:
- Review of recent clinical trial data.
- Analysis of treatment advancements in HF-pEF.
- Synthesis of evidence for guideline updates.
Main Results:
- HF-pEF management has shifted from symptom control to evidence-based therapies.
- SGLT2 inhibitors have demonstrated reduced HF hospitalizations.
- Newer agents like finerenone, semaglutide, and tirzepatide show emerging clinical benefits.
Conclusions:
- The treatment of HF-pEF has undergone significant evolution.
- Updated management strategies incorporating new pharmacotherapies are essential.
- Current recommendations require revision to reflect recent therapeutic evidence.
Abstract:
Heart failure (HF) is associated with high morbidity and mortality. HF with preserved left ventricular ejection fraction (HF-pEF) accounts for up to 50% of all HF cases, being the most common in elderly patients. In addition, these subjects frequently present other comorbidities. For all these reasons, the diagnosis of patients with HF-pEF is complex and requires a careful approach. In addition, there are "secondary" or HF-pEF forms that must also be discarded. The treatment of HF-pEF has evolved very significantly in recent years due to evidence from clinical trials. Until a few years ago, the management was based on the treatment of congestive symptoms with diuretics and comorbidities, to this was added the indication of treatment with SGLT2 inhibitors, after being shown to reduce hospitalizations due to HF, and more recently new evidence of clinical benefit with other drugs such as finerenone, semaglutide or tirzepatide has been published. All this makes it necessary to update the recommendations regarding the management of patients with HF-pEF.
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