Treatment of Heart Failure with Preserved Ejection Fraction

Abstract

Heart failure contributes to more than 1 million hospitalizations annually and is one of the most common causes of repeat hospitalizations in the elderly. Previously, it was thought that mortality from heart failure with preserved ejection fraction (PEF) was lower than that from heart failure with reduced ejection fraction (REF), but more recent data infer similar mortality. Although the mortality rate in patients with heart failure with REF is decreasing, the mortality rate in patients with heart failure with PEF remains unchanged--possibly due to the lack of evidence-based treatment regimens or greater recognition of the disease. Without sufficient trials in patients with heart failure with PEF, clinicians are forced to extrapolate treatment from data proven to benefit patients with heart failure with REF. There is no question that clinical trials including only patients with heart failure with PEF are limited. In addition, the definition and clinical diagnosis of this syndrome are not clearly defined, and the guidelines available for treatment lack specificity in recommendations. To describe the current literature for the treatment of heart failure with PEF, we conducted a MEDLINE search of the English-language literature (1950-2009) to identify studies that pertain to the treatment of patients with heart failure with PEF. Ongoing clinical trials continue, but until data become available, clinicians must base their treatment strategies for heart failure with PEF on sparse information.

Guideline‐Directed Medical Therapy and Survival Following Hospitalization in Patients with Heart Failure

“…Our study suggests that patients with HFrEF were more likely to be initiated on GDMT compared to those with HFpEF. This finding is not surprising considering the lack of evidence supporting GDMT in patients with HFpEF (7). A retrospective analysis of elderly patients with HFpEF enrolled in the OPTIMIZE-HF study reported no improvement in mortality or rehospitalization with newly started BB therapy (25).…”

“…In HFrEF, GDMT includes angiotensin-converting enzyme inhibitors (ACEI) (or angiotensin-receptor blockers (ARB) in ACEI-intolerant patients) and β blockers (BB) in all patients, as well as aldosterone-receptor antagonists (ARA), digoxin, nitrates, and hydralazine in select patients. Unfortunately, no therapy has shown a mortality benefit in patients with HF with preserved ejection fraction (HFpEF) (7).…”

Heart Failure with Preserved Ejection Fraction

“…4,6 LCZ696 is a new combination drug of the angiotensin II type 1 receptor (AT 1 ) blocker (ARB) valsartan and the neprilysin inhibitor prodrug AHU377 that has been developed by Novartis. This dual combination exerts a powerful vasodilatory and natriuresis effect by blocking angiotensin II activity on the one hand, while augmenting plasma levels of natriuretic peptides, such as BNP, on the other.…”

Targets for Heart Failure With Preserved Ejection Fraction

“…Careful laboratory monitoring is required on commencement and follow‐up. Finally, through analysis in the conduct of such large‐scale trials it is critical to inform patient care and future research …”