ABSTRACT
Heart failure (HF) with preserved left ventricular (LV) ejection fraction (HFpEF) is uncommon in younger persons, but highly prevalent in older adults, particularly women over age 80 years, in whom it comprises nearly 100% of new HF cases. Originally viewed as a disorder due solely to abnormalities in left ventricular diastolic function, our understanding has evolved such that HFpEF is now understood as likely a systemic syndrome, clinically heterogeneous with underlying age-related changes, frequent multiple chronic comorbidities and multi-organ involvement, such that HFpEF meets criteria for a true geriatric syndrome. Given such a multi-factorial, complex milieu, it is not surprising that trials of drugs and interventions aimed solely at altering cardiac hemodynamics have repeatedly failed to strongly impact their pre-determined clinical outcomes in HFpEF. To date, only exercise training and calorie restriction have been proven to improve exercise intolerance and quality of life, both key, clinically meaningful outcomes, in HFpEF. It will be fruitful for geriatricians and cardiologists to collaborate and develop novel models that employ geriatric principles for managing HFpEF patients.
