Guideline recommended treatment for heart failure with preserved ejection fraction (HFpEF)

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Guideline recommended treatment for heart failure with preserved ejection fraction (HFpEF)

Heart failure with preserved ejection fraction (HFpEF) is becoming a well recognized entity, occurring more often in the older age group with diastolic left ventricular dysfunction. But unlike in heart failure with reduced ejection fraction (HFrEF), guideline recommended therapeutic options are limited in HFpEF. At the same time, prognosis is not that better in HFpEF. Some of the guideline recommended therapeutic options in HFpEF are as follows:

  1. Systolic and diastolic blood pressures should be controlled as per clinical practice guidelines.
  2. Diuretics should be used for symptomatic relief when there is evidence of volume overload.
  3. Those who have angina or demonstrable myocardial ischemia, coronary revascularization may be beneficial. This is over and above medical therapy, if the worsening is considered to be due to myocardial ischemia.
  4. Management of atrial fibrillation as per clinical practice guidelines may be useful to improve symptomatic heart failure.
  5. Beta blockers, angiotensin converting enzyme inhibitors and and angiotensin receptor blockers may be used to control hypertension in HFpEF.
  6. In those without significant renal dysfunction or hyperkalemia, cautious use of aldosterone receptor antagonist may be useful to reduce hospitalization. Regular monitoring of renal function, serum potassium levels and diuretic dosing during treatment is desirable to avoid worsening renal function and hyperkalemia.
  7. Angiotensin receptor blockers may also have a similar role in reducing hospitalizations in patients with HFpEF.


  1. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Colvin MM, Drazner MH, Filippatos GS, Fonarow GC, Givertz MM, Hollenberg SM, Lindenfeld J, Masoudi FA, McBride PE, Peterson PN, Stevenson LW, Westlake C. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of AmericaCirculation. 2017 Aug 8;136(6):e137-e161. (Free full text)

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