Heart Failure With Preserved Ejection Fraction: A Practical, Evidence-Based Approach for Primary Care Clinicians

Heart failure with preserved ejection fraction represents an increasingly common cause of exertional intolerance in ambulatory practice. Because symptoms are frequently nonspecific and traditional signs of congestion may be absent at rest, diagnosis requires a structured approach that integrates clinical assessment, natriuretic peptide interpretation, and targeted evaluation of filling pressures. Management has evolved toward a multimodal strategy that can be initiated in primary care, combining foundational pharmacologic therapies found to reduce symptoms and hospitalizations with aggressive optimization of cardiometabolic comorbidities. This review translates contemporary guideline recommendations into a practical, outpatient-focused framework to support timely diagnosis and evidence-based management of heart failure with preserved ejection fraction.