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Current Management and Future Directions of Heart Failure With Preserved Ejection Fraction: a Contemporary Review

Current Treatment Options in Cardiovascular Medicine volume 20, Article number: 28 (2018) Cite this article

Abstract

Heart failure with preserved ejection fraction (HFpEF), a complex and debilitating syndrome, is commonly seen in elderly populations. Exacerbation of HFpEF is among the most common reasons for hospital admission in the USA. The high rate of morbidity and mortality from this condition underscores the fact that HFpEF is heterogeneous, complex, and poorly characterized. Randomized, controlled trials have been very successful at identifying treatments for HF with reduced ejection fraction (HFrEF), but effective treatment options for HFpEF are lacking. Here, we discuss (1) the pathophysiology of HFpEF, (2) a standardized diagnostic and therapeutic approach, (3) a comparison of the management of recent guidelines, and (4) challenges and future directions for HFpEF management. The authors believe that it is important to identify new subtypes of HFpEF to better classify genotypes and phenotypes of HFpEF and to develop novel targeted therapies. It is our hypothesis that big data analytics will shine new light on unique HFpEF phenotypes that better respond to treatment modalities.

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Abbreviations

AHA:

American Heart Association

ACC:

American College of Cardiology

ESC:

European Society of Cardiology

CABANA:

Catheter Ablation Versus Antiarrhythmic Drug Therapy for Atrial Fibrillation trial

RAFT-AF:

A Randomized Ablation-based Atrial Fibrillation Rhythm Control Versus Rate Control Trial in Patients with Heart Failure and High Burden Atrial Fibrillation

HYVET:

Hypertension in the Very Elderly Trial

J-DHF:

The Japanese Diastolic Heart Failure Study

COHERE registry:

Carvedilol Heart Failure Registry

SENIORS:

Study of Effects of Nebivolol Intervention on Outcomes and Rehospitalization in Seniors with Heart Failure trial

CIBIS-ELD:

Comparison of Bisoprolol and Carvedilol in Elderly HF Patients

OPTIMIZE-HF:

Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure

STRUCTURE:

SpironolacTone in myocaRdial dysfUnCTion with redUced exeRcisE capacity trial

TOPCAT:

Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist

PARAMOUNT:

Prospective comparison of ARNI with ARB on Management Of heart failUre with preserved ejectioN fracTion trial

CHAMPION:

The CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in NYHA Class III Heart Failure Patients trial

NEAT-HFpEF:

Nitrate’s Effect on Activity Tolerance in Heart Failure with Preserved Ejection Fraction trial

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Acknowledgements

The authors thank Professor W.H. Wilson Tang, MD, FACC, FAHA, FHFSA (Division of Cardiovascular Medicine, Cleveland Clinic’s Heart and Vascular Institute, OH, USA), for valuable comments and suggestions to improve the quality of the paper.

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  1. Division of Cardiovascular Diseases, Icahn School of Medicine at Mount Sinai, Mount Sinai St. Luke’s Hospital, Mount Sinai Heart, 1000 10th Ave, New York, NY, 10019, USA

    Chayakrit Krittanawong MD & Marrick L. Kukin MD, FACC, FAHA, FHFSA

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Krittanawong, C., Kukin, M.L. Current Management and Future Directions of Heart Failure With Preserved Ejection Fraction: a Contemporary Review. Curr Treat Options Cardio Med 20, 28 (2018). https://doi.org/10.1007/s11936-018-0623-1

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