Highlights & Basics
- Heart failure with preserved ejection fraction (HFpEF) is a complex clinical syndrome in which patients have symptoms and signs of heart failure, with left ventricular ejection fraction ≥50%.
- The most common risk factors and comorbidities are hypertension, obesity, chronic kidney disease, diabetes mellitus, and coronary artery disease. Advanced age and female sex are also important risk factors.
- Diagnosis is based on symptoms (commonly dyspnea), clinical evidence of congestion, measurement of natriuretic peptides, and comprehensive echocardiography. Scoring systems (H₂FPEF and HFA-PEFF) are available to help discriminate HFpEF from other causes of dyspnea.
- The goals of treatment are to reduce symptoms, reduce hospitalizations, and improve patients' functional status.
- Management includes identification and treatment of underlying causes and comorbidities, implementing lifestyle measures where appropriate (exercise, diet, weight control), and pharmacotherapy including sodium-glucose cotransporter-2 inhibitors, diuretics as needed, and consideration of aldosterone antagonists, angiotensin receptor-neprilysin inhibitors, and angiotensin-II receptor antagonists.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
Prevalence of individual chronic conditions in heart failure patients with preserved and reduced ejection fraction. Left panel, men; right panel, women
Impaired relaxation: mitral inflow showing E/A reversal
Pseudonormalization of E/A mitral inflow
Valsalva technique confirming impaired relaxation
Tissue Doppler imaging (TDI) of the basal LV showing increased E/E'
Mitral inflow confirming restrictive filling
CMR of patient with cardiac amyloid infiltration. Following injection of gadolinium contrast, in the late phase there is subendocardial basal ring in the left ventricle (4-chamber view)
CMR of patient with cardiac amyloid infiltration. Following injection of gadolinium contrast, in the late phase there is subendocardial basal ring in the left ventricle (short-axis basal image)
CMR (cardiac magnetic resonance) imaging demonstrating restrictive cardiomyopathy with biatrial dilatation and mild concentric left ventricular hypertrophy
CMR (cardiac magnetic resonance) imaging confirming left atrial enlargement and left ventricular hypertrophy (LVH)
Citations
Bozkurt B, Coats AJ, Tsutsui H, et al. Universal definition and classification of heart failure: a report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure. 2021 Mar 1;S1071-9164(21)00050-6.[Abstract][Full Text]
Kittleson MM, Panjrath GS, Amancherla K, et al. 2023 ACC expert consensus decision pathway on management of heart failure with preserved ejection fraction: a report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2023 May 9;81(18):1835-78.[Abstract][Full Text]
Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation. 2022 May 3;145(18):e895-1032.[Abstract][Full Text]
McDonagh TA, Metra M, Adamo M, et al. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021 Sep 21;42(36):3599-726.[Full Text]
McDonagh TA, Metra M, Adamo M, et al. 2023 focused update of the 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2023 Oct 1;44(37):3627-39.[Full Text]
Borlaug BA, Sharma K, Shah SJ, et al. Heart failure with preserved ejection fraction: JACC scientific statement. J Am Coll Cardiol. 2023 May 9;81(18):1810-34.[Abstract]
1. Bozkurt B, Coats AJ, Tsutsui H, et al. Universal definition and classification of heart failure: a report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure. 2021 Mar 1;S1071-9164(21)00050-6.[Abstract][Full Text]
2. Kittleson MM, Panjrath GS, Amancherla K, et al. 2023 ACC expert consensus decision pathway on management of heart failure with preserved ejection fraction: a report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2023 May 9;81(18):1835-78.[Abstract][Full Text]
3. Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation. 2022 May 3;145(18):e895-1032.[Abstract][Full Text]
4. McDonagh TA, Metra M, Adamo M, et al. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021 Sep 21;42(36):3599-726.[Full Text]
5. McDonagh TA, Metra M, Adamo M, et al. 2023 focused update of the 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2023 Oct 1;44(37):3627-39.[Full Text]
6. Youn JC, Ahn Y, Jung HO. Pathophysiology of heart failure with preserved ejection fraction. Heart Fail Clin. 2021 Jul;17(3):327-35.[Abstract]
7. Nagueh SF. Heart failure with preserved ejection fraction: insights into diagnosis and pathophysiology. Cardiovasc Res. 2021 Mar 21;117(4):999-1014.[Abstract][Full Text]
8. Redfield MM, Borlaug BA. Heart failure with preserved ejection fraction: a review. JAMA. 2023 Mar 14;329(10):827-38.[Abstract]
9. Martin SS, Aday AW, Almarzooq ZI, et al. 2024 heart disease and stroke statistics: a report of US and global data from the American Heart Association. Circulation. 2024 Feb 20;149(8):e347-913.[Abstract][Full Text]
10. Norhammar A, Bodegard J, Vanderheyden M, et al. Prevalence, outcomes and costs of a contemporary, multinational population with heart failure. Heart. 2023 Mar 10;109(7):548-56.[Abstract][Full Text]
11. Borlaug BA, Sharma K, Shah SJ, et al. Heart failure with preserved ejection fraction: JACC scientific statement. J Am Coll Cardiol. 2023 May 9;81(18):1810-34.[Abstract]
12. Owan TE, Hodge DO, Herges RM, et al. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med. 2006 Jul 20;355(3):251-9.[Abstract][Full Text]
13. Dunlay SM, Roger VL, Redfield MM. Epidemiology of heart failure with preserved ejection fraction. Nat Rev Cardiol. 2017 Oct;14(10):591-602.[Abstract][Full Text]
14. Bhatia RS, Tu JV, Lee DS, et al. Outcome of heart failure with preserved ejection fraction in a population-based study. N Engl J Med. 2006 Jul 20;355(3):260-9.[Abstract][Full Text]
15. Lenzen MJ, Scholte op Reimer WJ, Boersma E, et al. Differences between patients with a preserved and a depressed left ventricular function: a report from the EuroHeart Failure Survey. Eur Heart J. 2004;25:1214-1220.[Abstract][Full Text]
16. Tarantini L, Faggiano P, Senni M, et al. Clinical features and prognosis associated with a preserved left ventricular systolic function in a large cohort of congestive heart failure outpatients managed by cardiologists: data from the Italian Network on Congestive Heart Failure. Ital Heart J. 2002 Nov;3(11):656-64.[Abstract]
17. Masoudi FA, Havranek EP, Smith G, et al. Gender, age, and heart failure with preserved left ventricular systolic function. J Am Coll Cardiol. 2003 Jan 15;41(2):217-23.[Abstract][Full Text]
18. Screever EM, van der Wal MHL, van Veldhuisen DJ, et al. Comorbidities complicating heart failure: changes over the last 15 years. Clin Res Cardiol. 2023 Jan;112(1):123-33.[Abstract][Full Text]
19. Lam CS, Donal E, Kraigher-Krainer E, et al. Epidemiology and clinical course of heart failure with preserved ejection fraction. Eur J Heart Fail. 2011 Jan;13(1):18-28.[Abstract][Full Text]
20. Hess OM, Grimm J, Krayenbuehl HP. Diastolic simple elastic and viscoelastic properties of the left ventricle in man. Circulation. 1979 Jun;59(6):1178-87.[Abstract][Full Text]
21. Sanderson JE, Gibson DG, Brown DJ, et al. Left ventricular filling in hypertrophic cardiomyopathy. An angiographic study. Br Heart J. 1977 Jun;39(6):661-70.[Abstract][Full Text]
22. Zipes DP, Libby P, Bonow RO, et al. (eds). Braunwald's heart disease: a textbook of cardiovascular medicine. 7th ed. Philadelphia, PA: Elsevier Saunders; 2005.
23. Paulus WJ, Tschöpe C. A novel paradigm for heart failure with preserved ejection fraction: comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation. J Am Coll Cardiol. 2013 Jul 23;62(4):263-71.[Abstract][Full Text]
24. Shah SJ, Kitzman DW, Borlaug BA, et al. Phenotype-specific treatment of heart failure with preserved ejection fraction: a multiorgan roadmap. Circulation. 2016 Jul 5;134(1):73-90.[Abstract][Full Text]
25. Vasan RS, Benjamin EJ, Levy D. Congestive heart failure with normal left ventricular systolic function: clinical approaches to the diagnosis and treatment of diastolic heart failure. Arch Intern Med. 1996 Jan 22;156(2):146-57.[Abstract]
26. Smit MD, Moes ML, Maass AH, et al. The importance of whether atrial fibrillation or heart failure develops first. Eur J Heart Fail. 2012 Sep;14(9):1030-40.[Abstract][Full Text]
27. Zile MR, Brutsaert DL. New concepts in diastolic dysfunction and diastolic heart failure: Part I: diagnosis, prognosis, and measurements of diastolic function. Circulation. 2002 Mar 19;105(11):1387-93.[Abstract][Full Text]
28. Zile MR, Brutsaert DL. New concepts in diastolic dysfunction and diastolic heart failure: Part II: causal mechanisms and treatment. Circulation. 2002 Mar 26;105(12):1503-8.[Abstract][Full Text]
29. Stolfo D, Uijl A, Vedin O, et al. Sex-based differences in heart failure across the ejection fraction spectrum: phenotyping, and prognostic and therapeutic implications. JACC Heart Fail. 2019 Jun;7(6):505-15.[Abstract][Full Text]
30. Pulignano G, Del Sindaco D, Tavazzi L, et al. Clinical features and outcomes of elderly outpatients with heart failure followed up in hospital cardiology units: data from a large nationwide cardiology database (IN-CHF Registry). Am Heart J. 2002 Jan;143(1):45-55.[Abstract]
31. Hogg K, Swedberg K, McMurray J. Heart failure with preserved left ventricular systolic function; epidemiology, clinical characteristics, and prognosis. J Am Coll Cardiol. 2004 Feb 4;43(3):317-27.[Abstract][Full Text]
32. Okura Y, Ohno Y, Ramadan MM, et al. Characterization of outpatients with isolated diastolic dysfunction and evaluation of the burden in a Japanese community. Circ J. 2007 Jul;71(7):1013-21.[Abstract]
33. Borlaug BA, Jensen MD, Kitzman DW, et al. Obesity and heart failure with preserved ejection fraction: new insights and pathophysiological targets. Cardiovasc Res. 2023 Feb 3;118(18):3434-50.[Abstract][Full Text]
34. Burden S, Weedon B, Whaymand L, et al. The effect of overweight/obesity on diastolic function in children and adolescents: a meta-analysis. Clin Obes. 2021 Oct;11(5):e12476.[Abstract][Full Text]
35. Ammar KA, Redfield MM, Mahoney DW, et al. Central obesity: association with left ventricular dysfunction and mortality in the community. Am Heart J. 2008 Nov;156(5):975-81.[Abstract]
36. John JE, Claggett B, Skali H, et al. Coronary artery disease and heart failure with preserved ejection fraction: the ARIC study. J Am Heart Assoc. 2022 Sep 6;11(17):e021660.[Abstract][Full Text]
37. McHugh K, DeVore AD, Wu J, et al. Heart failure with preserved ejection fraction and diabetes: JACC state-of-the-art review. J Am Coll Cardiol. 2019 Feb 12;73(5):602-11.[Abstract][Full Text]
38. Dunlay SM, Givertz MM, Aguilar D, et al. Type 2 diabetes mellitus and heart failure: a scientific statement from the American Heart Association and the Heart Failure Society of America: this statement does not represent an update of the 2017 ACC/AHA/HFSA heart failure guideline update. Circulation. 2019 Aug 13;140(7):e294-324.[Abstract][Full Text]
39. Pop-Busui R, Januzzi JL, Bruemmer D, et al. Heart failure: an underappreciated complication of diabetes. A consensus report of the American Diabetes Association. Diabetes Care. 2022 Jul 7;45(7):1670-90.[Abstract][Full Text]
40. Hayashi SY, Rohani M, Lindholm B, et al. Left ventricular function in patients with chronic kidney disease evaluated by colour tissue Doppler velocity imaging. Nephrol Dial Transplant. 2006 Jan;21(1):125-32.[Abstract][Full Text]
41. Unger ED, Dubin RF, Deo R, et al. Association of chronic kidney disease with abnormal cardiac mechanics and adverse outcomes in patients with heart failure and preserved ejection fraction. Eur J Heart Fail. 2016 Jan;18(1):103-12.[Abstract][Full Text]
42. Patel RN, Sharma A, Prasad A, et al. Heart failure with preserved ejection fraction with CKD: a narrative review of a multispecialty disorder. Kidney Med. 2023 Dec;5(12):100705.[Abstract][Full Text]
43. van de Wouw J, Broekhuizen M, Sorop O, et al. Chronic kidney disease as a risk factor for heart failure with preserved ejection fraction: a focus on microcirculatory factors and therapeutic targets. Front Physiol. 2019;10:1108.[Abstract][Full Text]
44. Shah SJ, Katz DH, Selvaraj S, et al. Phenomapping for novel classification of heart failure with preserved ejection fraction. Circulation. 2015 Jan 20;131(3):269-79.[Abstract][Full Text]
45. Chang HM, Moudgil R, Scarabelli T, et al. Cardiovascular complications of cancer therapy: best practices in diagnosis, prevention, and management: Part 1. J Am Coll Cardiol. 2017 Nov 14;70(20):2536-51.[Abstract][Full Text]
46. Purwowiyoto SL, Prawara AS. Metabolic syndrome and heart failure: mechanism and management. Med Pharm Rep. 2021 Jan;94(1):15-21.[Abstract][Full Text]
47. Ndumele CE, Rangaswami J, Chow SL, et al. Cardiovascular-kidney-metabolic health: a presidential advisory from the American Heart Association. Circulation. 2023 Nov 14;148(20):1606-35.[Abstract][Full Text]
48. Ndumele CE, Neeland IJ, Tuttle KR, et al. A synopsis of the evidence for the science and clinical management of cardiovascular-kidney-metabolic (CKM) syndrome: a scientific statement from the American Heart Association. Circulation. 2023 Nov 14;148(20):1636-64.[Abstract][Full Text]
49. Chan J, Sanderson J, Chan W, et al. Prevalence of sleep-disordered breathing in diastolic heart failure. Chest. 1997 Jun;111(6):1488-93.[Abstract]
50. Kim SH, Cho GY, Shin C, et al. Impact of obstructive sleep apnea on left ventricular diastolic function. Am J Cardiol. 2008 Jun 1;101(11):1663-8.[Abstract]
51. Otto ME, Belohlavek M, Romero-Corral A, et al. Comparison of cardiac structural and functional changes in obese otherwise healthy adults with versus without obstructive sleep apnea. Am J Cardiol. 2007 May 1;99(9):1298-302.[Abstract]
52. Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Circulation. 2019 Sep 10;140(11):e596-646.[Abstract][Full Text]
53. Lloyd-Jones DM, Allen NB, Anderson CAM, et al. Life's Essential 8: Updating and Enhancing the American Heart Association's Construct of Cardiovascular Health: A Presidential Advisory From the American Heart Association. Circulation. 2022 Aug 2;146(5):e18-e43.[Abstract][Full Text]
54. Sciarretta S, Palano F, Tocci G, et al. Antihypertensive treatment and development of heart failure in hypertension: a Bayesian network meta-analysis of studies in patients with hypertension and high cardiovascular risk. Arch Intern Med. 2011 Mar 14;171(5):384-94.[Abstract][Full Text]
55. Upadhya B, Stacey RB, Kitzman DW. Preventing heart failure by treating systolic hypertension: what does the SPRINT add? Curr Hypertens Rep. 2019 Jan 18;21(1):9.[Abstract]
56. US Preventive Services Task Force. Healthy diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: behavioral counseling interventions. November 2020 [internet publication].[Full Text]
57. US Preventive Services Task Force. Healthy diet and physical activity for cardiovascular disease prevention in adults without cardiovascular disease risk factors: behavioral counseling interventions. July 2022 [internet publication].[Full Text]
58. Jurgens CY, Lee CS, Aycock DM, et al. State of the science: the relevance of symptoms in cardiovascular disease and research: a scientific statement from the American Heart Association. Circulation. 2022 Sep 20;146(12):e173-e184.[Abstract][Full Text]
59. Criteria Committee of the New York Heart Association. Nomenclature and criteria for diagnosis of diseases of the heart and great vessels. 9th ed. Boston, MA: Little, Brown & Co; 1964:253-6.
60. Reddy YNV, Kaye DM, Handoko ML, et al. Diagnosis of heart failure with preserved ejection fraction among patients with unexplained dyspnea. JAMA Cardiol. 2022 Sep 1;7(9):891-99.[Abstract][Full Text]
61. Reddy YNV, Carter RE, Obokata M, et al. A simple, evidence-based approach to help guide diagnosis of heart failure with preserved ejection fraction. Circulation. 2018 Aug 28;138(9):861-70.[Abstract][Full Text]
62. Pieske B, Tschöpe C, de Boer RA, et al. How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur Heart J. 2019 Oct 21;40(40):3297-3317.[Abstract][Full Text]
63. Verbrugge FH, Omote K, Reddy YNV, et al. Heart failure with preserved ejection fraction in patients with normal natriuretic peptide levels is associated with increased morbidity and mortality. Eur Heart J. 2022 May 21;43(20):1941-51.[Abstract][Full Text]
64. Anjan VY, Loftus TM, Burke MA, et al. Prevalence, clinical phenotype, and outcomes associated with normal B-type natriuretic peptide levels in heart failure with preserved ejection fraction. Am J Cardiol. 2012 Sep 15;110(6):870-6.[Abstract][Full Text]
65. Feola M, Aspromonte N, Canali C, et al. Prognostic value of plasma brain natriuretic peptide, urea nitrogen, and creatinine in outpatients >70 years of age with heart failure. Am J Cardiol. 2005 Sep 1;96(5):705-9.[Abstract]
66. van Veldhuisen DJ, Linssen GC, Jaarsma T, et al. B-type natriuretic peptide and prognosis in heart failure patients with preserved and reduced ejection fraction. J Am Coll Cardiol. 2013 Apr 9;61(14):1498-506.[Abstract][Full Text]
67. Myhre PL, Vaduganathan M, Claggett B, et al. B-type natriuretic peptide during treatment with sacubitril/valsartan: the PARADIGM-HF trial. J Am Coll Cardiol. 2019 Mar 26;73(11):1264-72.[Abstract][Full Text]
68. Kirkpatrick JN, Vannan MA, Narula J, et al. Echocardiography in heart failure: applications, utility, and new horizons. J Am Coll Cardiol. 2007;50:381-396.[Abstract][Full Text]
69. Nagueh SF, Appleton CP, Gillebert TC, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Eur J Echocardiogr. 2009;10:165-193.[Abstract][Full Text]
70. Chamsi-Pasha MA, Zhan Y, Debs D, et al. CMR in the evaluation of diastolic dysfunction and phenotyping of HFpEF: current role and future perspectives. JACC Cardiovasc Imaging. 2020 Jan;13(1 pt 2):283-96.[Abstract][Full Text]
71. Anker SD, Comin Colet J, Filippatos G, et al; FAIR-HF Trial Investigators. Ferric carboxymaltose in patients with heart failure and iron deficiency. N Engl J Med. 2009 Dec 17;361(25):2436-48.[Abstract][Full Text]
72. Ponikowski P, van Veldhuisen DJ, Comin-Colet J, et al; CONFIRM-HF Investigators. Beneficial effects of long-term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiency. Eur Heart J. 2015 Mar 14;36(11):657-68.[Abstract][Full Text]
73. Rathi VK, Doyle M, Yamrozik J, et al. Routine evaluation of left ventricular diastolic function by cardiovascular magnetic resonance: a practical approach. J Cardiovasc Magn Reson. 2008 Jul 8;10:36. [Abstract][Full Text]
74. Marsan NA, Westenberg JJ, Tops LF, et al. Comparison between tissue Doppler imaging and velocity-encoded magnetic resonance imaging for measurement of myocardial velocities, assessment of left ventricular dyssynchrony, and estimation of left ventricular filling pressures in patients with ischemic cardiomyopathy. Am J Cardiol. 2008 Nov 15;102(10):1366-72.[Abstract]
75. Muntwyler J, Abetel G, Gruner C, et al. One-year mortality among unselected outpatients with heart failure. Eur Heart J. 2002 Dec;23(23):1861-6.[Abstract]
76. McKee PA, Castelli WP, McNamara PM, et al. The natural history of congestive heart failure: the Framingham study. N Engl J Med. 1971 Dec 23;285(26):1441-6.[Abstract]
77. Expert Panel on Cardiac Imaging, White RD, Kirsch J, et al. ACR Appropriateness Criteria(®) suspected new-onset and known nonacute heart failure. J Am Coll Radiol. 2018 Nov;15(11s):S418-S431.[Abstract][Full Text]
78. Smiseth OA, Morris DA, Cardim N, et al. Multimodality imaging in patients with heart failure and preserved ejection fraction: an expert consensus document of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2022 Jan 24;23(2):e34-e61.[Abstract][Full Text]
79. National Institute for Health and Care Excellence. Acute heart failure: diagnosis and management. November 2021 [internet publication].[Full Text]
80. National Institute for Health and Care Excellence. Chronic heart failure in adults: diagnosis and management. September 2018 [internet publication].[Full Text]
81. Aggarwal M, Bozkurt B, Panjrath G, et al. Lifestyle modifications for preventing and treating heart failure. J Am Coll Cardiol. 2018 Nov 6;72(19):2391-405.[Abstract][Full Text]
82. Hieda M, Sarma S, Hearon CM Jr, et al. One-year committed exercise training reverses abnormal left ventricular myocardial stiffness in patients with stage B heart failure with preserved ejection fraction. Circulation. 2021 Sep 21;144(12):934-46.[Abstract][Full Text]
83. Kang DS, Sung JH, Kim D, et al. Association between exercise habit changes and mortality following a cardiovascular event. Heart. 2022 Nov 24;108(24):1945-51.[Abstract][Full Text]
84. Sachdev V, Sharma K, Keteyian SJ, et al. Supervised exercise training for chronic heart failure with preserved ejection fraction: a scientific statement from the American Heart Association and American College of Cardiology. Circulation. 2023 Apr 18;147(16):e699-715.[Abstract][Full Text]
85. Paluch AE, Boyer WR, Franklin BA, et al. Resistance exercise training in individuals with and without cardiovascular disease: 2023 update: a scientific statement from the American Heart Association. Circulation. 2024 Jan 16;149(3):e217-31.[Abstract][Full Text]
86. Thomas RJ, Beatty AL, Beckie TM, et al. Home-based cardiac rehabilitation: a scientific statement from the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Heart Association, and the American College of Cardiology. Circulation. 2019 Jul 2;140(1):e69-89.[Abstract][Full Text]
87. McDonagh ST, Dalal H, Moore S, et al. Home-based versus centre-based cardiac rehabilitation. Cochrane Database Syst Rev. 2023 Oct 27;10(10):CD007130.[Abstract]
88. Golbus JR, Lopez-Jimenez F, Barac A, et al. Digital technologies in cardiac rehabilitation: a science advisory from the American Heart Association. Circulation. 2023 Jul 4;148(1):95-107.[Abstract][Full Text]
89. Ezekowitz JA, Colin-Ramirez E, Ross H, et al; SODIUM-HF Investigators. Reduction of dietary sodium to less than 100 mmol in heart failure (SODIUM-HF): an international, open-label, randomised, controlled trial. Lancet. 2022 Apr 9;399(10333):1391-400.[Abstract]
90. National Institute for Health and Care Excellence. Dapagliflozin for treating chronic heart failure with preserved or mildly reduced ejection fraction. Jun 2023 [internet publication].[Full Text]
91. National Institute for Health and Care Excellence. Empagliflozin for treating chronic heart failure with preserved or mildly reduced ejection fraction. Nov 2023 [internet publication].[Full Text]
92. Anker SD, Butler J, Filippatos G, et al. Empagliflozin in heart failure with a preserved ejection fraction. N Engl J Med. 2021 Oct 14;385(16):1451-61.[Abstract][Full Text]
93. Filippatos G, Butler J, Farmakis D, et al. Empagliflozin for heart failure with preserved left ventricular ejection fraction with and without diabetes. Circulation. 2022 Aug 30;146(9):676-86.[Abstract][Full Text]
94. Ferreira JP, Zannad F, Butler J, et al. Association of empagliflozin treatment with albuminuria levels in patients with heart failure: a secondary analysis of EMPEROR-Pooled. JAMA Cardiol. 2022 Nov 1;7(11):1148-59.[Abstract][Full Text]
95. Butler J, Packer M, Siddiqi TJ, et al. Efficacy of empagliflozin in patients with heart failure across kidney risk categories. J Am Coll Cardiol. 2023 May 16;81(19):1902-14.[Abstract][Full Text]
96. Packer M, Butler J, Zeller C, et al. Blinded withdrawal of long-term randomized treatment with empagliflozin or placebo in patients with heart failure. Circulation. 2023 Sep 26;148(13):1011-22.[Abstract][Full Text]
97. Packer M, Butler J, Zannad F, et al. Effect of empagliflozin on worsening heart failure events in patients with heart failure and preserved ejection fraction: EMPEROR-Preserved trial. Circulation. 2021 Oct 19;144(16):1284-94.[Abstract][Full Text]
98. Butler J, Filippatos G, Jamal Siddiqi T, et al. Empagliflozin, health status, and quality of life in patients with heart failure and preserved ejection fraction: the EMPEROR-Preserved trial. Circulation. 2022 Jan 18;145(3):184-93.[Abstract][Full Text]
99. Butler J, Filippatos G, Siddiqi TJ, et al. Effects of empagliflozin in women and men with heart failure and preserved ejection fraction. Circulation. 2022 Oct 4;146(14):1046-55.[Abstract][Full Text]
100. Böhm M, Butler J, Filippatos G, et al. Empagliflozin improves outcomes in patients with heart failure and preserved ejection fraction irrespective of age. J Am Coll Cardiol. 2022 Jul 5;80(1):1-18.[Abstract][Full Text]
101. Butler J, Usman MS, Filippatos G, et al. Safety and efficacy of empagliflozin and diuretic use in patients with heart failure and preserved ejection fraction: a post hoc analysis of the EMPEROR-preserved trial. JAMA Cardiol. 2023 Jul 1;8(7):640-9.[Abstract][Full Text]
102. Nassif ME, Windsor SL, Borlaug BA, et al. The SGLT2 inhibitor dapagliflozin in heart failure with preserved ejection fraction: a multicenter randomized trial. Nat Med. 2021 Nov;27(11):1954-60.[Abstract][Full Text]
103. Nassif ME, Windsor SL, Gosch K, et al. Dapagliflozin improves heart failure symptoms and physical limitations across the full range of ejection fraction: pooled patient-level analysis from DEFINE-HF and PRESERVED-HF trials. Circ Heart Fail. 2023 Jul;16(7):e009837.[Abstract][Full Text]
104. Solomon SD, McMurray JJV, Claggett B, et al. Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med. 2022 Sep 22;387(12):1089-98.[Abstract][Full Text]
105. Cunningham JW, Vaduganathan M, Claggett BL, et al. Dapagliflozin in patients recently hospitalized with heart failure and mildly reduced or preserved ejection fraction. J Am Coll Cardiol. 2022 Oct 4;80(14):1302-10.[Abstract][Full Text]
106. Vaduganathan M, Claggett BL, Jhund P, et al. Time to clinical benefit of dapagliflozin in patients with heart failure wth mildly reduced or preserved ejection fraction: a prespecified secondary analysis of the DELIVER randomized clinical trial. JAMA Cardiol. 2022 Dec 1;7(12):1259-63.[Abstract][Full Text]
107. Desai AS, Jhund PS, Claggett BL, et al. Effect of dapagliflozin on cause-specific mortality in patients with heart failure across the spectrum of ejection fraction: a participant-level pooled analysis of DAPA-HF and DELIVER. JAMA Cardiol. 2022 Dec 1;7(12):1227-34.[Abstract][Full Text]
108. Mc Causland FR, Claggett BL, Vaduganathan M, et al. Dapagliflozin and kidney outcomes in patients with heart failure with mildly reduced or preserved ejection fraction: a prespecified analysis of the DELIVER randomized clinical trial. JAMA Cardiol. 2023 Jan 1;8(1):56-65.[Abstract]
109. Inzucchi SE, Claggett BL, Vaduganathan M, et al. Efficacy and safety of dapagliflozin in patients with heart failure with mildly reduced or preserved ejection fraction by baseline glycaemic status (DELIVER): a subgroup analysis from an international, multicentre, double-blind, randomised, placebo-controlled trial. Lancet Diabetes Endocrinol. 2022 Dec;10(12):869-81.[Abstract]
110. Yang M, Butt JH, Kondo T, et al. Dapagliflozin in patients with heart failure with mildly reduced and preserved ejection fraction treated with a mineralocorticoid receptor antagonist or sacubitril/valsartan. Eur J Heart Fail. 2022 Dec;24(12):2307-19.[Abstract][Full Text]
111. Jhund PS, Claggett BL, Talebi A, et al. Effect of dapagliflozin on total heart failure events in patients with heart failure with mildly reduced or preserved ejection fraction: a prespecified analysis of the DELIVER trial. JAMA Cardiol. 2023 Jun 1;8(6):554-63.[Abstract][Full Text]
112. Kondo T, Jering KS, Borleffs CJW, et al. Patient characteristics, outcomes, and effects of dapagliflozin according to the duration of heart failure: a prespecified analysis of the DELIVER trial. Circulation. 2023 Apr 4;147(14):1067-78.[Abstract][Full Text]
113. Chatur S, Vaduganathan M, Claggett BL, et al. Outpatient worsening among patients with mildly reduced and preserved ejection fraction heart failure in the DELIVER trial. Circulation. 2023 Nov 28;148(22):1735-45.[Abstract][Full Text]
114. Chatur S, Vaduganathan M, Claggett B, et al. Dapagliflozin and diuretic utilization in heart failure with mildly reduced or preserved ejection fraction: the DELIVER trial. Eur Heart J. 2023 Aug 14;44(31):2930-43.[Abstract][Full Text]
115. Kosiborod MN, Bhatt AS, Claggett BL, et al. Effect of dapagliflozin on health status in patients with preserved or mildly reduced ejection fraction. J Am Coll Cardiol. 2023 Feb 7;81(5):460-73.[Abstract][Full Text]
116. Peikert A, Chandra A, Kosiborod MN, et al. Association of dapagliflozin vs placebo with individual Kansas City cardiomyopathy questionnaire components in patients with heart failure with mildly reduced or preserved ejection fraction: a secondary analysis of the DELIVER trial. JAMA Cardiol. 2023 Jul 1;8(7):684-90.[Abstract][Full Text]
117. Butt JH, Jhund PS, Belohlávek J, et al. Efficacy and safety of dapagliflozin according to frailty in patients with heart failure: a prespecified analysis of the DELIVER trial. Circulation. 2022 Oct 18;146(16):1210-24.[Abstract][Full Text]
118. Adamson C, Kondo T, Jhund PS, et al. Dapagliflozin for heart failure according to body mass index: the DELIVER trial. Eur Heart J. 2022 Nov 1;43(41):4406-17.[Abstract][Full Text]
119. Wang X, Vaduganathan M, Claggett BL, et al. Sex differences in characteristics, outcomes, and treatment response with dapagliflozin across the range of ejection fraction in patients with heart failure: insights from DAPA-HF and DELIVER. Circulation. 2023 Feb 21;147(8):624-34.[Abstract]
120. Vaduganathan M, Docherty KF, Claggett BL, et al. SGLT-2 inhibitors in patients with heart failure: a comprehensive meta-analysis of five randomised controlled trials. Lancet. 2022 Sep 3;400(10354):757-67.[Abstract]
121. Cardoso R, Graffunder FP, Ternes CMP, et al. SGLT2 inhibitors decrease cardiovascular death and heart failure hospitalizations in patients with heart failure: a systematic review and meta-analysis. EClinicalMedicine. 2021 Jun;36:100933.[Abstract][Full Text]
122. Banerjee M, Pal R, Nair K, et al. SGLT2 inhibitors and cardiovascular outcomes in heart failure with mildly reduced and preserved ejection fraction: A systematic review and meta-analysis. Indian Heart J. 2023 Mar-Apr;75(2):122-7.[Abstract][Full Text]
123. Usman MS, Siddiqi TJ, Anker SD, et al. Effect of SGLT2 inhibitors on cardiovascular outcomes across various patient populations. J Am Coll Cardiol. 2023 Jun 27;81(25):2377-87.[Abstract]
124. Xiang B, Zhang R, Wu X, et al. Optimal pharmacologic treatment of heart failure with preserved and mildly reduced ejection fraction: a meta-analysis. JAMA Netw Open. 2022 Sep 1;5(9):e2231963.[Abstract][Full Text]
125. Gupta K, Spertus JA, Birmingham M, et al. Racial differences in quality of life in patients with heart failure treated with sodium-glucose cotransporter 2 inhibitors: a patient-level meta-analysis of the CHIEF-HF, DEFINE-HF, and PRESERVED-HF trials. Circulation. 2023 Jul 18;148(3):220-8.[Abstract][Full Text]
126. Martin N, Manoharan K, Davies C, et al. Beta-blockers and inhibitors of the renin-angiotensin aldosterone system for chronic heart failure with preserved ejection fraction. Cochrane Database Syst Rev. 2021 May 22;5(5):CD012721.[Abstract][Full Text]
127. Pitt B, Pfeffer MA, Assmann SF, et al. Spironolactone for heart failure with preserved ejection fraction. N Engl J Med. 2014 Apr 10;370(15):1383-92.[Abstract][Full Text]
128. Pfeffer MA, Claggett B, Assmann SF, et al. Regional variation in patients and outcomes in the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT) trial. Circulation. 2015 Jan 6;131(1):34-42.[Abstract][Full Text]
129. Solomon SD, Claggett B, Lewis EF, et al. Influence of ejection fraction on outcomes and efficacy of spironolactone in patients with heart failure with preserved ejection fraction. Eur Heart J. 2016 Feb 1;37(5):455-62.[Abstract][Full Text]
130. Solomon SD, McMurray JJV, Anand IS, et al. Angiotensin-neprilysin inhibition in heart failure with preserved ejection fraction. N Engl J Med. 2019 Oct 24;381(17):1609-20.[Abstract][Full Text]
131. McMurray JJV, Jackson AM, Lam CSP, et al. Effects of sacubitril-valsartan versus valsartan in women compared with men with heart failure and preserved ejection fraction: insights from PARAGON-HF. Circulation. 2020 Feb 4;141(5):338-51.[Abstract][Full Text]
132. Pieske B, Wachter R, Shah SJ, et al. Effect of sacubitril/valsartan vs standard medical therapies on plasma NT-proBNP concentration and submaximal exercise capacity in patients with heart failure and preserved ejection fraction: the PARALLAX randomized clinical trial. JAMA. 2021 Nov 16;326(19):1919-29.[Abstract][Full Text]
133. Yusuf S, Pfeffer MA, Swedberg K, et al. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-preserved trial. Lancet. 2003 Sep 6;362(9386):777-81.[Abstract]
134. Powell-Wiley TM, Poirier P, Burke LE, et al. Obesity and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2021 May 25;143(21):e984-e1010.[Abstract][Full Text]
135. Lunney M, Ruospo M, Natale P, et al. Pharmacological interventions for heart failure in people with chronic kidney disease. Cochrane Database Syst Rev. 2020 Feb 27;2(2):CD012466.[Abstract][Full Text]
136. Philbin EF, Santella RN, Rocco TA Jr. Angiotensin-converting enzyme inhibitor use in older patients with heart failure and renal dysfunction. J Am Geriatr Soc. 1999 Mar;47(3):302-8.[Abstract]
137. Risler T, Schwab A, Kramer B, et al. Comparative pharmacokinetics and pharmacodynamics of loop diuretics in renal failure. Cardiology. 1994;84 Suppl 2:155-61.[Abstract]
138. Kosiborod MN, Abildstrøm SZ, Borlaug BA, et al. Semaglutide in patients with heart failure with preserved ejection fraction and obesity. N Engl J Med. 2023 Sep 21;389(12):1069-84.[Abstract]
139. Borlaug BA, Kitzman DW, Davies MJ, et al. Semaglutide in HFpEF across obesity class and by body weight reduction: a prespecified analysis of the STEP-HFpEF trial. Nat Med. 2023 Sep;29(9):2358-65.[Abstract][Full Text]
140. Udelson JE, Lewis GD, Shah SJ, et al. Effect of praliciguat on peak rate of oxygen consumption in patients with heart failure with preserved ejection fraction: the CAPACITY HFpEF randomized clinical trial. JAMA. 2020 Oct 20;324(15):1522-31.[Abstract][Full Text]
141. Adamson PB, Abraham WT, Bourge RC, et al. Wireless pulmonary artery pressure monitoring guides management to reduce decompensation in heart failure with preserved ejection fraction. Circ Heart Fail. 2014 Nov;7(6):935-44.[Abstract][Full Text]
142. Lindenfeld J, Zile MR, Desai AS, et al. Haemodynamic-guided management of heart failure (GUIDE-HF): a randomised controlled trial. Lancet. 2021 Sep 11;398(10304):991-1001.[Abstract]
143. Writing Committee, Maddox TM, Januzzi JL Jr, et al. 2021 update to the 2017 ACC expert consensus decision pathway for optimization of heart failure treatment: answers to 10 pivotal issues about heart failure with reduced ejection fraction: a report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2021 Feb 16;77(6):772-810.[Abstract][Full Text]
144. O'Meara E, McDonald M, Chan M, et al. CCS/CHFS heart failure guidelines: clinical trial update on functional mitral regurgitation, SGLT2 inhibitors, ARNI in HFpEF, and tafamidis in amyloidosis. Can J Cardiol. 2020 Feb;36(2):159-69.[Abstract][Full Text]
145. Cleland JG, Taylor J, Freemantle N, et al. Relationship between plasma concentrations of N-terminal pro brain natriuretic peptide and the characteristics and outcome of patients with a clinical diagnosis of diastolic heart failure: a report from the PEP-CHF study. Eur J Heart Fail. 2012 May;14(5):487-94.[Abstract][Full Text]
146. von Haehling S, van Veldhuisen DJ, Roughton M, Babalis D, et al. Anaemia among patients with heart failure and preserved or reduced ejection fraction: results from the SENIORS study. Eur J Heart Fail. 2011 Jun;13(6):656-63.[Abstract][Full Text]
147. Rutledge T, Reis VA, Linke SE, et al. Depression in heart failure: a meta-analytic review of prevalence, intervention effects, and associations with clinical outcomes. J Am Coll Cardiol. 2006;48:1527-1537.[Abstract][Full Text]
148. Gottlieb SS, Kop WJ, Ellis SJ, et al; HF-ACTION Investigators. Relation of depression to severity of illness in heart failure (from Heart Failure And a Controlled Trial Investigating Outcomes of Exercise Training [HF-ACTION]). Am J Cardiol. 2009;103:1285-1289.[Abstract][Full Text]
149. Jiang W, Kuchibhatla M, Clary GL, et al. Relationship between depressive symptoms and long-term mortality in patients with heart failure. Am Heart J. 2007;154:102-108.[Abstract]
150. Johnson TJ, Basu S, Pisani BA, et al. Depression predicts repeated heart failure hospitalizations. J Card Fail. 2012 Mar;18(3):246-52.[Abstract]
151. Somaratne JB, Whalley GA, Poppe KK, et al. Pseudonormal mitral filling is associated with similarly poor prognosis as restrictive filling in patients with heart failure and coronary heart disease: a systematic review and meta-analysis of prospective studies. J Am Soc Echocardiogr. 2009 May;22(5):494-8.[Abstract]
152. Al-Khatib SM, Shaw LK, O'Connor C, et al. Incidence and predictors of sudden cardiac death in patients with diastolic heart failure. J Cardiovasc Electrophysiol. 2007 Dec;18(12):1231-5.[Abstract]
153. Lai YC, Wang L, Gladwin MT. Insights into the pulmonary vascular complications of heart failure with preserved ejection fraction. J Physiol. 2019 Feb;597(4):1143-56.[Abstract][Full Text]
154. Brittain EL, Thenappan T, Huston JH, et al. Elucidating the clinical implications and pathophysiology of pulmonary hypertension in heart failure with preserved ejection fraction: a call to action: a science advisory from the American Heart Association. Circulation. 2022 Aug 16;146(7):e73-e88.[Abstract][Full Text]
155. Sidhu K, Sanjanwala R, Zieroth S. Hyperkalemia in heart failure. Curr Opin Cardiol. 2020 Mar;35(2):150-5.[Abstract][Full Text]
156. James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014 Feb 5;311(5):507-20.[Abstract][Full Text]
157. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. J Am Coll Cardiol. 2018 May 15;71(19):e127-248.[Abstract][Full Text]
158. Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018 Sep 1;39(33):3021-104.[Abstract][Full Text]
159. National Institute for Health and Care Excellence. Hypertension in adults: diagnosis and management. Nov 2023 [internet publication].[Full Text]
160. Chow SL, Bozkurt B, Baker WL, et al. Complementary and alternative medicines in the management of heart failure: a scientific statement from the American Heart Association. Circulation. 2023 Jan 10;147(2):e4-e30.[Abstract][Full Text]
161. Melgar M, Britton A, Roper LE, et al. Use of respiratory syncytial virus vaccines in older adults: recommendations of the Advisory Committee on Immunization Practices - United States, 2023. MMWR Morb Mortal Wkly Rep. 2023 Jul 21;72(29):793-801.[Abstract][Full Text]
162. Taylor RS, Davies EJ, Dalal HM, et al. Effects of exercise training for heart failure with preserved ejection fraction: a systematic review and meta-analysis of comparative studies. Int J Cardiol. 2012 Dec 15;162(1):6-13.[Abstract]
