Heart failure with preserved ejection fraction update: A review of clinical trials and new therapeutic considerations

Between 2013 and 2016 there were approximately 6.2 million adults in the United States living with heart failure; nearly half had an ejection fraction that was preserved. Despite the high prevalence of heart failure with preserved ejection fraction (HFpEF), our understanding of this disease is limited and it still carries significant morbidity and mortality worldwide. At present, physicians are burdened by the inconclusive benefits of currently available treatment options. Recently the scientific community has seen an influx of new pathophysiology studies and outcome trials that have reshaped our understanding of HFpEF as a complex, multi-systemic disease. Pharmacological trials involving beta-blockers, angiotensin II receptor antagonists, aldosterone antagonists, and angiotensin-neprilysin inhibitors have demonstrated encouraging results, but have yet to reach the significance of advancements made in the treatment of heart failure with reduced ejection fraction. This review aims to summarize landmark clinical trials that have influenced current treatment guidelines, and reports on emerging evidence supporting/refuting new treatment modalities including pharmacotherapy, lifestyle modification and device therapy. (Cardiol J 2022; 29, 4: 670–679).