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Feature Article Cardiovascular medicine
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Heart failure with preserved ejection fraction: improving diagnosis and management

Shane Nanayakkara, Justin A Mariani, David M Kaye

Heart failure with preserved ejection fraction (HFpEF) is increasing in prevalence and often presents a diagnostic and therapeutic dilemma. The use of well-defined diagnostic criteria and exercise testing improves the accuracy of diagnosis, and new drugs and devices are being developed to treat these patients.

Key Points
  • Heart failure with preserved ejection fraction (HFpEF, previously known as diastolic heart failure) is equally as common as heart failure with reduced ejection fraction (HFrEF, systolic heart failure) but is less well understood.
  • HFpEF is an emerging epidemic, due to the increasing age of the population as well as the increasing incidence of common risk factors such as obesity and hypertension.
  • Recognition of the typical signs and symptoms of heart failure in the setting of specific echocardiographic features is key to diagnosis. The diagnosis can be confirmed with exercise right heart catheterisation.
  • Key principles of management in patients with HFpEF are blood pressure control, physical activity, optimisation of comorbidities and judicious volume management.
  • Few therapies are effective at reducing morbidity or mortality in HFpEF at present. Active research is under way to develop appropriate diagnostic and management strategies.

    Picture credit: © Patrick Heagney/ Models used for illustrative purposes only.

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