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Therapy for heart failure with preserved ejection fraction: current status, unique challenges, and future directions

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Abstract

Heart failure (HF) with preserved ejection fraction (HFpEF) is the most common form of HF. Among elderly women, HFpEF comprises more than 80% of incident HF cases. Adverse outcomes—exercise intolerance, poor quality of life, frequent hospitalizations, and reduced survival—approach those of classic HF with reduced EF (HFrEF). However, despite its importance, our understanding of the pathophysiology of HFpEF is incomplete, and despite intensive efforts, optimal therapy remains uncertain, as most trials to date have been negative. This is in stark contrast to management of HFrEF, where dozens of positive trials have established a broad array of effective, guidelines-based therapies that definitively improve a range of clinically meaningful outcomes. In addition to providing an overview of current management status, we examine evolving data that may help explain this paradox, overcome past challenges, provide a roadmap for future success, and that underpin a wave of new trials that will test novel approaches based on these insights.

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Authors and Affiliations

  1. Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1045, USA

    Bharathi Upadhya & Dalane W. Kitzman

  2. College of Nursing and Health Innovation, University of Texas Arlington, Arlington, TX, USA

    Mark J. Haykowsky

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  1. Bharathi Upadhya
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Correspondence to Dalane W. Kitzman.

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D.W.K. declares the following relationships: consultant for Abbvie, Bayer, Merck, Medtronic, GSK, Relypsa, Regeneron, Merck, Corvia Medical, DCRI, and Actavis, research grant funding from Novartis, St. Luke’s Medical Center, and stock ownership in Gilead Sciences.

B.U. has received research funding from Novartis and Corvia.

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Supported in part by: NIH Grants R01AG045551 and R01AG18915; The Claude D. Pepper Older Americans Independence Center of Wake Forest School of Medicine Winston-Salem, NC, and National Institute of Nursing Research Grant R15NR016826.

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Upadhya, B., Haykowsky, M.J. & Kitzman, D.W. Therapy for heart failure with preserved ejection fraction: current status, unique challenges, and future directions. Heart Fail Rev 23, 609–629 (2018). https://doi.org/10.1007/s10741-018-9714-z

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