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Heart Failure With Preserved Ejection Fraction: A Practical, Evidence-Based Approach for Primary Care Clinicians
Stephanie A Saey1, Fadi Adel2, Horng Chen2
1Department of Internal Medicine. Mayo Clinic, Rochester, MN.
Mayo Clinic Proceedings
|June 1, 2026
Summary
Heart failure with preserved ejection fraction (HFpEF) is a common cause of exercise limitation. This review outlines a practical approach for primary care to diagnose and manage HFpEF, focusing on symptom relief and comorbidity optimization.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Practice
Background:
- Heart failure with preserved ejection fraction (HFpEF) is a growing cause of exertional intolerance.
- Nonspecific symptoms and absent resting congestion signs complicate HFpEF diagnosis.
- Current management requires a structured, integrated approach.
Purpose of the Study:
- To provide a practical, outpatient-focused framework for diagnosing HFpEF.
- To translate guideline recommendations into actionable management strategies.
- To support primary care clinicians in managing HFpEF.
Main Methods:
- Integrating clinical assessment for diagnosis.
- Utilizing natriuretic peptide interpretation.
- Performing targeted evaluation of cardiac filling pressures.
- Implementing a multimodal management strategy.
Main Results:
- A structured diagnostic approach is essential for HFpEF.
- Pharmacologic therapies can reduce HFpEF symptoms and hospitalizations.
- Optimizing cardiometabolic comorbidities is crucial for management.
Conclusions:
- Timely diagnosis of HFpEF is achievable in ambulatory settings.
- Evidence-based management involves pharmacotherapy and comorbidity control.
- This framework supports effective outpatient HFpEF care.
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