Heart failure with preserved left ventricular ejection fraction – clinical perspectives

Abstract

Heart failure with preserved ejection fraction (HFpEF) is an increasingly recognized subtype of heart failure, particularly affecting older adults and women. It accounts for approximately 51–63% of heart failure cases, and its prevalence continues to rise, largely due to aging populations and an increasing burden of comorbidities such as hypertension, diabetes, obesity, and chronic kidney disease. The European Society of Cardiology (ESC) and American Heart Association (AHA) guidelines emphasize a combination of clinical symptoms, preserved left ventricular ejection fraction (LVEF ≥ 50%), elevated natriuretic peptides, and echocardiographic markers of diastolic dysfunction for diagnosis. Additionally, diagnostic algorithms such as the HFA-PEFF score and H2FPEF score aid in differentiating HFpEF from other cardiovascular and non-cardiovascular diseases. Until recently, HFpEF treatment focused mainly on symptom relief and comorbidity management. However, newer pharmacological therapies have demonstrated benefits in reducing hospitalizations and improving cardiovascular outcomes. Prognosis in HFpEF remains poor, with a 5-year mortality rate of approximately 75%. Thus patients with HFpEF require comprehensive management that includes lifestyle modifications, optimized pharmacotherapy, and rigorous control of comorbid conditions. Currently presented review summarizes practical aspects of HFpEF diagnosis, pathophysiology, treatment and prognosis focusing on multidisciplinary approaches and early intervention strategies may improve outcomes for patients affected by this challenging condition.

Keywords

• heart failure
• heart failure with preserved ejection fraction
• diastolic dysfunction