Pharmacotherapy of Heart Failure with Preserved Ejection Fraction

Heart failure with preserved ejection fraction ( HF p EF ) constitutes ~50% of all heart failure diagnoses and is associated with considerable morbidity and mortality. The treatment of HF p EF can be challenging due to a lack of evidence supporting the benefit of various drug therapies. In practice, treatment can be divided into acute and chronic management. Acute therapy for decompensated heart failure is similar for both HF p EF and heart failure with reduced ejection fraction. The mainstay of treatment is diuretics to reduce volume overload and improve dyspnea. Patients with an acute exacerbation of HF p EF and rapid atrial fibrillation ( AF ) should be rate controlled with negative chronotropic agents. For chronic therapy, patients with HF p EF should not be treated like patients with heart failure with reduced ejection fraction. Chronic management of HF p EF can be simplified by using three strategies based on applicability: treat precipitating conditions (e.g., hypertension, AF ), control symptoms by maintaining euvolemia with diuretics, and avoid therapies that have been shown not to be beneficial unless another compelling indication exists. Nondrug interventions for HF p EF include salt and fluid restriction, regular physical activity, and referral to a heart function clinic, if appropriate.