Heart Failure With Preserved Ejection Fraction

Heart failure is a complex clinical syndrome in which impaired ventricular filling and ejection of blood into circulation causes decreased stroke volume and cardiac output. Heart failure with preserved ejection fraction (50% or more) is the most common type of heart failure, and up to 1 in 10 adults will be affected in their lifetime. Clinical symptoms such as peripheral edema, dyspnea, and orthopnea, with clinical findings including jugular venous distention, third heart sound, and laterally displaced apical impulse should prompt consideration of heart failure. Laboratory values (eg, elevated N-terminal fragment of the prohormone brain natriuretic peptide) can also aid in diagnosis, which can then be confirmed with specific echocardiographic findings. Once heart failure with preserved ejection fraction is diagnosed, medications should be initiated to manage comorbid symptoms and conditions such as hypertension, obesity, and obstructive sleep apnea. Sodium-glucose cotransporter-2 inhibitors have been shown to reduce hospitalizations related to heart failure and cardiovascular-related mortality in patients with symptomatic heart failure, elevated natriuretic peptide levels, and an ejection fraction more than 40%; therefore, they should be considered in all patients with heart failure with preserved ejection fraction. Additionally, loop diuretics, mineralocorticoid receptor antagonists, and angiotensin receptor blocker/neprilysin inhibitors can be used. In patients with end-organ dysfunction or signs of refractory treatment, consultation with a heart failure specialist should be considered.