Management of heart failure with preserved ejection fraction

Heart failure with preserved ejection fraction is a highly heterogenous disease. There is emerging evidence that treatment should be tailored to the individual’s associated comorbidities No current algorithms exist for the management of heart failure with preserved ejection fraction. Conventional therapies used in heart failure with reduced ejection fraction are yet to show a mortality benefit Key treatment objectives include control of hypertension and fluid balance Common comorbidities include coronary artery disease, atrial fibrillation, obesity, diabetes, renal impairment and pulmonary hypertension. These comorbidities should be considered in all patients and treatment optimised Keywords: diet, diuresis, exercise, heart failure Introduction Heart failure usually presents as exercise intolerance due to exertional dyspnoea. It is categorised according to left ventricular ejection fraction: heart failure with preserved ejection fraction (HFpEF, also known as diastolic dysfunction) heart failure with reduced ejection fraction (HFrEF). Heart failure affects over half a million Australians and accounts for 1.6% of all hospitalisations. Approximately half of these cases are due to HFpEF. Despite sharing the same clinical symptoms, patients with a preserved ejection fraction tend to be older, more frequently female and obese, and have higher rates of comorbidities compared to those with a reduced ejection fraction.1-3 Although there have been significant advances in the management of HFrEF with several pharmacologic and device-based therapies recommended by guidelines, the current therapeutic options in HFpEF may alleviate symptoms but do not significantly reduce mortality.