HEART FAILURE WITH PRESERVED EJECTION FRACTION (HFpEF): TREATMENT OPTIONS AND PATIENT OUTCOMES

Hu et al specified that HFpEF is undoubtedly a major as well as a diverse structural type of heart failure affecting nearly half of the new patients identified globally. Compared to HFrEF, a similar situation is observed in HFpEF where the underlying mechanisms of the disease are broader and it is extremely difficult to manage the disorder. This study found that, despite optimal medical therapy, patients with HFpEF had marked symptom burden, high hospitalization rate, and reduced health-related quality of life, indicating the need for better therapeutic management strategies. The systematic review of the current treatment of patients diagnosed with HFpEF will focus on the effectiveness of the current treatments. In this regard, the review aims to determine the knowledge gaps that are evident within available literature and proposals for subsequent clinical investigations. The current literature search incorporated the databases PubMed, Cochrane Library, Embase, and Web of Science, adhering to the PRISMA protocol. Article inclusion was guided by specific conditions namely, clinical trials, observation studies, and systemic reviews comparing treatments for HFpEF. Data extraction and quality assessment were performed using standard tools that made the tools very reliable and valid. Overall, the review found 45 closed trials that met the eligibility criterion. Previous pharmacological treatments including the ARNIs, SGLT2i and MRAs had a modest effect in decreasing CV hospitalizations but had a neutral to small effect on all-cause mortality. Frequent devices such as lifestyle changes and exercise protocols were seen to upgrade functional ability besides increasing the quality of life of HFpEF. However, none of these treatments are highly effective, always necessitating a combination and individualized treatment approach. In conclusion, the therapy of HFpEF presents itself with several therapeutic options that have shown promising results but the complexity of the disorder is due to the wide divergence in its clinical presentation. These results suggest that pharmacotherapy should be further complemented with lifestyle modifications to improve the functioning of patients. More work has to be done to precisely define individual therapeutic approaches addressing the heterogeneous pathophysiology of HFpEF and to set clear clinical recommendations.