Heart failure with preserved ejection fraction management: a systematic review of clinical practice guidelines and recommendations

Abstract

Multiple guidelines exist for the diagnosis and management of heart failure with preserved ejection fraction (HFpEF). We systematically reviewed current guidelines and recommendations, developed by national and international medical organizations, on the management of HFpEF in adults to aid clinical decision-making. We searched MEDLINE and EMBASE on 28 February 2024 for publications over the last 10 years as well as websites of organizations relevant to guideline development. Of the 10 guidelines and recommendations retrieved, 7 showed considerable rigour of development and were subsequently retained for analysis. There was consensus on the definition of HFpEF and the diagnostic role of serum natriuretic peptides and resting transthoracic echocardiography. Discrepancies were identified in the thresholds of serum natriuretic peptides and transthoracic echocardiography parameters used to diagnose HFpEF. There was agreement on the general pharmacological and supportive management of acute and chronic HFpEF. However, differences exist in strategies to identify and address specific phenotypes. Contemporary guidelines for HFpEF management agree on measures to avoid its development and the consideration of cardiac transplantation in advanced diseases. There were discrepancies in recommended frequency of surveillance for patients with HFpEF and sparse recommendations on screening for HFpEF in the general population, use of diagnostic scoring systems, and the role of newly emerging therapies.

Keywords: Diastolic dysfunction; Guideline recommendations; Heart failure; Heart failure with preserved ejection fraction; Systematic review.

Figure 1

Summary of the guideline search and review process. The number of guidelines at each step is indicated. AGREE II, Appraisal of Guidelines for Research and Evaluation II.

Figure 2

Summary of clinical practice guidelines and recommendations on heart failure with preserved ejection fraction management. CMR, cardiovascular magnetic resonance; CPET, cardiopulmonary exercise testing; GLP-1, glucagon-like peptide-1; HFpEF, heart failure with preserved ejection fraction; MRA, mineralocorticoid receptor antagonist; NP, natriuretic peptide; RAAS, renin-angiotensin-aldosterone system; SGLT2/1, sodium-glucose co-transporter 2/1; TTE, transthoracic echocardiography.