Management of Heart Failure With Preserved Ejection Fraction: 2026 ACC Expert Consensus Decision Pathway

James L. Januzzi Jr.Hutter Professor of Medicine, Harvard Medical School

“I would argue that underdiagnosis is probably more of a concern than overdiagnosis, given the fact that a person who has dyspnea, atrial fibrillation, and obesity, even before we start off with diagnostic testing, most likely has heart failure with preserved ejection fraction. Clinicians therefore really need to have a high index of suspicion for the presence of heart failure because treatment in that situation can improve quality of life and functional capacity and can potentially reduce mortality and hospitalization risk.”

“Really for everyone with HFpEF at this point, we know there's incredible value for the SGLT2 inhibitors, which improve outcomes across the spectrum of heart failure, definitely improving symptoms and reducing hospitalization, with some mixed signals regarding mortality. And now we've got finerenone, the nonsteroidal MRA, which also reduces the risk of heart failure hospitalizations.”

“In clinical practice, the HFpEF-ABA score would function most readily as a screening tool in the primary care setting or in the electronic medical record, with the probability of HFpEF prompting further imaging, natriuretic peptide testing, cardiology referral, or all of these. In cardiology practices where access to echocardiographic data is available, the H 2 FPEF score may be easily calculated and potentially more useful than the HFA-PEFF, given evidence of greater accuracy despite fewer input variables.”