HFpEF in Asia-Clinical Characterization and Therapeutic Strategies

Heart failure with preserved ejection fraction (HFpEF) prevalence is increasing in Asia, driven by aging populations and rising cardiometabolic risk. Asian patients with HFpEF present a decade earlier than Western counterparts, carry a disproportionate burden of diabetes, chronic kidney disease, and visceral adiposity at lower body mass index thresholds, and exhibit marked regional heterogeneity in clinical subtypes and outcomes. Diagnosis remains challenging, as algorithms derived in Western populations perform suboptimally in Asian patients, and access to echocardiography and natriuretic peptide testing is highly variable across the region. Artificial intelligence-enabled tools can bridge these diagnostic gaps. Therapeutically, sodium-glucose cotransporter 2 inhibitors demonstrate consistent benefit across Asian subgroups, whereas glucagon-like peptide-1 receptor agonists and nonsteroidal mineralocorticoid receptor antagonists represent important emerging options, though evidence in lean Asian subtypes remains limited. This review examines the diagnosis, clinical heterogeneity, clinical outcomes, and treatment of HFpEF across Asia, highlighting priorities for future research and quality of care.