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Review
. 2023 Jun;11(6):619-636.
doi: 10.1016/j.jchf.2023.03.011. Epub 2023 May 3.

How to Manage Heart Failure With Preserved Ejection Fraction: Practical Guidance for Clinicians

Akshay S Desai  1 , Carolyn S P Lam  2 , John J V McMurray  3 , Margaret M Redfield  4
Affiliations
Free article
Review

How to Manage Heart Failure With Preserved Ejection Fraction: Practical Guidance for Clinicians

Akshay S Desai et al. JACC Heart Fail. 2023 Jun.
Free article

Abstract

Although patients with heart failure with preserved ejection fraction (HFpEF) (left ventricular ejection fraction ≥50%) comprise nearly half of those with chronic heart failure, evidence-based treatment options for this population have historically been limited. Recently, however, emerging data from prospective, randomized trials enrolling patients with HFpEF have greatly altered the range of pharmacologic options to modify disease progression in selected patients with HFpEF. In the context of this evolving landscape, clinicians are increasingly in need of practical guidance regarding the best approach to management of this growing population. In this review, the authors build on the recently published heart failure guidelines by integrating contemporary data from recent randomized trials to provide a contemporary framework for diagnosis and evidence-based treatment of patients with HFpEF. Where gaps in knowledge persist, the authors provide "best available" data from post hoc analyses of clinical trials or data from observational studies to guide management until more definitive studies are available.

Keywords: chronic heart failure; heart failure with preserved ejection fraction.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Desai has received institutional research grants from AstraZeneca, Abbott, Alnylam, Bayer, and Novartis; has received consulting fees from Abbott, Alnylam, AstraZeneca, Axon Therapeutics, Avidity Biopharma, Bayer, Biofourmis, Cytokinetics, GlaxoSmithKline, Medpace, Merck, New Amsterdam, Novartis, Parexel, Roche, Regeneron, Veristat, and Verily. Dr Lam has received a Clinician Scientist Award from the National Medical Research Council of Singapore; has received research support from Bayer and Roche Diagnostics; has served as consultant or on the advisory board/steering committee/executive committee for Actelion, Alleviant Medical, Allysta Pharma, Amgen, AnaCardio AB, Applied Therapeutics, AstraZeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Cytokinetics, Darma Inc, EchoNous Inc, Eli Lilly, Impulse Dynamics, Intellia Therapeutics, Ionis Pharmaceutical, Janssen Research and Development LLC, Medscape/WebMD Global LLC, Merck, Novartis, Novo Nordisk, Prosciento Inc, Radcliffe Group Ltd, ReCor Medical, Roche Diagnostics, Sanofi, Siemens Healthcare Diagnostics, and Us2.ai; and serves as cofounder and nonexecutive director of Us2.ai. Dr McMurray has received a British Heart Foundation Centre of Research Excellence Grant RE/18/6/34217; has received payments through Glasgow University from work on clinical trials; has received fees for consulting and other activities from Alnylam, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, BMS, Cardurion, Cytokinetics, Dal-Cor, GlaxoSmithKline, Ionis, KBP Biosciences, Novartis, Pfizer, and Theracos; and has received personal lecture fees from Corpus, Abbott, Hikma, Sun Pharmaceuticals, Medscape/Heart.Org, Radcliffe Cardiology, Servier Director, and Global Clinical Trial Partners (GCTP). Dr Redfield has reported that she has no relationships relevant to the contents of this paper to disclose.

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