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Treatment and prognosis of heart failure with preserved ejection fraction

Authors
Barry A Borlaug, MD
Wilson S Colucci, MD
Section Editor
Stephen S Gottlieb, MD
Deputy Editor
Susan B Yeon, MD, JD, FACC

INTRODUCTION

Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome in which patients have symptoms and signs of HF with normal or near normal left ventricular EF (LVEF >50 percent) [1]. Most patients also display evidence of diastolic dysfunction (eg, abnormal pattern of LV filling and elevated filling pressures) [2-5]. By contrast, HF with a reduced EF (HFrEF) is characterized by increased LV volumes and reduced EF. Among all patients with HF, as many as half have a normal or near normal LVEF [2]. Previously, HFpEF was termed “diastolic HF” and HFrEF was described as “systolic HF.” HFpEF should be distinguished from other causes of HF with an LVEF >50 percent such as valvular heart disease, pericardial disease, and high output HF (table 1).

The treatment and prognosis of patients with HFpEF will be reviewed here. Issues related to etiology, clinical manifestations, diagnosis, and pathophysiology are discussed separately. (See "Clinical manifestations and diagnosis of heart failure with preserved ejection fraction" and "Pathophysiology of diastolic heart failure" and "Cellular mechanisms of diastolic dysfunction".)

TREATMENT

Treatment overview — Clinical trials in heart failure with preserved ejection fraction (HFpEF) have produced neutral results to date and treatment is largely directed toward associated conditions (eg, hypertension) and symptoms (eg, edema). Recommendations for pharmacologic therapy are discussed below. (See 'Pharmacologic therapy' below.)

This approach is consistent with recommendations for treatment of patients with HFpEF included in the 2013 American College of Cardiology Foundation/American Heart Association (ACC/AHA) HF guidelines [6]. The following two strong recommendations were included:

Systolic and diastolic hypertension should be controlled in accordance with published clinical practice guidelines to prevent morbidity.

                            

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Literature review current through: Jan 2016. | This topic last updated: Nov 17, 2015.
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