ABSTRACT
Heart failure (HF) with preserved ejection fraction (HFpEF) is the most common form of HF in patients older than 65 years. Among elderly women living in the community, HFpEF comprises nearly 90% of incident HF cases. The health and economic impact of HFpEF is at least as great as that of HF with reduced ejection fraction (HFrEF) with similar rates of hospitalization for HF and substantial mortality. Despite the importance of HFpEF, our understanding of its pathophysiology remains incomplete, and recently, the concept of HFpEF has evolved from a “cardio-centric” model to a syndrome that involves multiple cardiovascular and non-cardiovascular mechanisms. Unlike the management of HFrEF, there is a paucity of large evidence-based trials demonstrating morbidity and mortality benefit for the treatment of HFpEF. Previous studies of pharmacological agents in HFpEF have proved neutral or negative, in part due to phenotypic heterogeneity and complex underlying mechanisms. The lack of effective treatments for HFpEF represents a large and growing unmet need in cardiology today. This chapter provides an overview of current data and guidelines as well as emerging treatments that are being evaluated in human clinical trials.
