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

Heart Failure (W Tang, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Heart Failure

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.

Keywords

Heart failure HFpEF Management Review Big data analytics 

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

Notes

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.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Cardiovascular Diseases, Icahn School of Medicine at Mount SinaiMount Sinai St. Luke’s Hospital, Mount Sinai HeartNew YorkUSA

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