Exercise Intolerance in Older Adults With Heart Failure With Preserved Ejection Fraction

Exercise intolerance (EI) is the primary manifestation of chronic heart failure with preserved ejection fraction (HFpEF), the most common form of HF among older individuals. The recent recognition that HFpEF is likely a systemic, multi-organ disorder that shares characteristics with other common, difficult-to-treat aging-related disorders suggest that novel insights may be gained from combining knowledge and concepts from aging and cardiovascular disease disciplines. This state-of-the-art review is based on the outcomes of an NIA-sponsored working group meeting on aging and EI in HFpEF. We discuss aging-related and extra-cardiac contributors to EI in HFpEF, and provide the rationale for a transdisciplinary, ‘gero-centric’ approach to advance our understanding of EI in HFpEF and identify promising new therapeutic targets. We also provide a framework for prioritizing future research, including developing a uniform, comprehensive approach to phenotypic characterization of HFpEF, elucidating key geroscience targets for treatment, and conducting proof-of-concept trials to modify these targets.