Heart Failure with Preserved Ejection Fraction: Management Guidelines

Journal of the Association of Physician of India (JAPI) reports a set of guidelines as Spironolactone and sacubitril-valsartan are beneficial in subsets of heart failure with preserved ejection fraction, especially with the lower range of ejection fraction (EF). The guideline states that SGLT2i, empagliflozin and dapagliflozin, and probably sotagliflozin are the only currently available drugs that have shown benefits in Heart failure with preserved ejection fraction, mostly by reducing hospitalizations.

Lifestyle modifications are important in structured cardiac rehabilitation and weight loss in the obese has shown to benefit patients. Dietary salt and fluid restriction help to minimize congestion and should be considered in patients who have features of volume overload. Tobacco cessation and restriction of alcohol consumption should be advised. Treatment of comorbidities is essential for to control of hypertension, correction of anemia, and heart rate control especially in atrial fibrillation (AF) is very important. Myocardial ischemia should be assessed and treated.

Renal dysfunction is a common accompaniment of Heart failure with preserved ejection fraction and pharmacotherapy should be modified according to the renal function. Vaccination for influenza and pneumococcus should be considered whenever appropriate. Sleep patterns should be assessed to look for obstructive sleep apnea.

The use of organic nitrates, phosphodiesterase-5 inhibitors, digoxin, and beta-blockers should be avoided in patients with Heart failure with preserved ejection fraction.

Researchers, therefore, concluded that diagnosis can sometimes be difficult and requires detailed evaluation with echocardiography and biomarkers. Lifestyle modifications and control of risk factors are very important in the management of Heart failure with preserved ejection fraction. Treatment of comorbidities is essential. There are few available drugs which have shown benefits, mostly by reducing hospitalizations in both diabetic and nondiabetic patients with Heart failure with preserved ejection fraction.

Reference: Harikrishnan S, Oomman A, Jadhav UM, et al. Heart Failure with Preserved Ejection Fraction: Management Guidelines (From Heart Failure Association of India, Endorsed by Association of Physicians of India). J Assoc Physicians India 2022;70(8):71–73.