Heart failure is a clinical diagnosis

-Heart failure with persevered ejection vs heart failure with reduced ejection fraction can only be diagnosed via echocardiography

Heart failure with reduced ejection fraction is not purely a disease of diastolic dysfunction


Patients with HFpEF almost always have hypertension, and are more likely to be older, female, and obese

-Two-thirds of patients still have CAD (>50% lesions)

-May benefit from PCI

HFpEF comprises 50% of CHF

-Five-year mortality is 60%

Acute management is the same as HFrEF

-Diuretics, preload reduction, afterload reduction, inotropes, vasopressors, ultrafiltration/HD

-Note that afterload reduction is not as effective in HFpEF as it is in HFrEF There is no clearly effective chronic management, though aldosterone antagonists have shown promise, and ARNIs and SGLT2 inhibitors are currently being studied HFpEF is beginning to be viewed as more of a systemic/inflammatory condition, and may be treated as such in the future