What question did this study set out to answer?

To review the etiology, pathophysiology, outpatient diagnostic workup, and holistic management strategies for heart failure with preserved ejection fraction (HFpEF).

December 6, 2020Postgraduate MedicineOpen Access

Heart failure with preserved ejection fraction: strategies for disease management and emerging therapeutic approaches

Q: What is the clinical evidence from this study?

Study design: Review. Population: Heart failure with preserved ejection fraction (HFpEF). Intervention: Primary care management.

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Key result

Primary care management is critical for HFpEF, comprising ~50% of cases and lacking approved treatments.

Why the study?

In contrast to HFrEF, no approved treatments are specifically indicated for HFpEF, and its diagnosis and comorbidity management present unique challenges in primary care.

Key Points

To review the etiology, pathophysiology, outpatient diagnostic workup, and holistic management strategies for heart failure with preserved ejection fraction (HFpEF).
Literature review evaluating diagnostic challenges in outpatient settings, disease pathophysiology, and differentiation of HFpEF from normal aging.
Assessment of multidisciplinary clinical workflows, comorbidity-targeted interventions, symptom management, and primary care provider roles across the HFpEF continuum.
Heart failure with preserved ejection fraction accounts for approximately 50% of all heart failure cases, with an incidence rate rising relative to heart failure with reduced ejection fraction.
Targeted disease-modifying therapies specifically approved for HFpEF remain absent, requiring clinical strategies to prioritize symptom relief and comorbidity control.
Outpatient diagnosis is complicated by a high burden of coexisting medical conditions and overlapping features with typical age-related physiological decline.

Structured PICO

Population

Patients with heart failure with preserved ejection fraction (HFpEF)

Intervention

Disease management and emerging therapeutic approaches

This review highlights the increasing prevalence of HFpEF and the critical role of primary care providers in its holistic management.

Implication

Emphasizes primary care role in rising HFpEF cases without approved therapies; leaves open optimal strategies and targeted trials.

Abstract

Approximately 50% of patients with heart failure (HF) have a preserved ejection fraction (HFpEF), and the incidence of HFpEF is increasing relative to HF with reduced ejection fraction (HFrEF). Both types of HF are associated with reduced survival and increased risk for hospitalization. However, in contrast to HFrEF, there are no approved treatments specifically indicated for HFpEF, and current therapy is largely focused on management of symptoms and comorbidities. Diagnosis of HFpEF in the outpatient setting also presents unique challenges compared with HFrEF because of factors including a high burden of comorbidities in HFpEF and difficulties in distinguishing HFpEF from normal aging. Primary care providers (PCPs) play a pivotal role in the delivery of holistic, patient-centric care from diagnosis to management and palliative care. As the prevalence of HF continues to rise in an aging population, PCPs will need to play a greater role in HFpEF care. This article will review HFpEF etiology and pathophysiology, diagnostic workup, and management of symptoms and comorbidities, with a focus on the critical role of PCPs throughout the clinical course of HFpEF.

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Cite This Study

Tóth et al. (2020) conducted a review in Heart failure with preserved ejection fraction (HFpEF). Primary care management was evaluated. Primary care management of heart failure with preserved ejection fraction is critical, as this condition accounts for approximately 50% of all heart failure patients and lacks approved treatments.

synapsesocial.com/papers/6a0aa7e4c2fd2491b670a5cb https://doi.org/10.1080/00325481.2020.1842620