Heart failure with preserved ejection fraction (HFpEF) is a condition where the heart’s main pumping chamber, the left ventricle, contracts normally but becomes stiff and does not relax properly. This stiffness prevents adequate blood filling, increasing heart pressure and reducing blood flow. It is an increasingly common form of heart failure, affecting about half of all heart failure patients. Treatment primarily aims to manage symptoms and enhance well-being.
Key Medication Strategies
Sodium-glucose cotransporter 2 (SGLT2) inhibitors, such as empagliflozin and dapagliflozin, are an important treatment for HFpEF. These medications help the kidneys remove excess glucose and sodium through urine, reducing fluid volume, cardiac wall stress, and improving heart energy efficiency. Clinical trials show SGLT2 inhibitors decrease heart failure hospitalizations and improve quality of life.
Mineralocorticoid receptor antagonists (MRAs), including spironolactone and eplerenone, are another beneficial approach in managing HFpEF. These drugs counteract aldosterone, a hormone causing fluid retention and heart fibrosis. MRAs reduce heart failure hospitalizations and improve diastolic function.
Angiotensin receptor-neprilysin inhibitors (ARNIs) may be considered for certain HFpEF patients. They widen blood vessels and reduce fluid. While not broadly beneficial, ARNIs may help patients with lower preserved ejection fractions. For these patients, ARNIs can reduce heart failure hospitalizations and improve kidney function.
Diuretics are important for managing fluid overload and symptoms in HFpEF. Loop diuretics help eliminate excess fluid and salt, reducing swelling and shortness of breath. While diuretics provide symptom relief, they do not directly alter disease progression or improve long-term outcomes. Their role is to improve comfort and alleviate congestion.
Addressing Related Health Conditions
HFpEF often coexists with several other health conditions, and managing these comorbidities is integral to HFpEF treatment.
Hypertension, or high blood pressure, is a major risk factor for HFpEF, and its control is important. Blood pressure below 130/80 mmHg is recommended. This often involves medications like SGLT2 inhibitors, angiotensin receptor blockers (ARBs), and MRAs, which also benefit HFpEF.
Diabetes is another common comorbidity that impacts HFpEF. High blood sugar and metabolic changes contribute to heart muscle stiffness and inflammation. While glycemic control benefits cardiovascular health, its specific impact on HFpEF outcomes is still being explored, though SGLT2 inhibitors show promise.
Atrial fibrillation (AF), an irregular heart rate, is common in HFpEF and can worsen symptoms and outcomes. Managing AF involves controlling the heart’s rate or restoring a normal heart rhythm. Evidence suggests a rhythm control strategy could improve survival in HFpEF patients with AF.
Obesity is a significant and increasing risk factor for HFpEF. Intentional weight loss can improve symptoms and exercise capacity. Even modest weight reduction can improve cardiorespiratory fitness and heart structure. Weight management programs, including dietary interventions, are effective.
Chronic kidney disease (CKD) and anemia are common in individuals with HFpEF. CKD can worsen heart function. Anemia is associated with reduced exercise capacity and poorer quality of life. Addressing these conditions is part of management.
Lifestyle and Other Therapies
Dietary modifications are an important aspect of HFpEF management, emphasizing sodium restriction. Limiting sodium intake to around 2 grams per day helps manage fluid retention and reduces the heart’s burden. While fluid restriction may be considered for severe fluid overload, avoiding excessive fluid intake is generally advised.
Regular physical activity and cardiac rehabilitation programs are beneficial for HFpEF patients. Exercise training improves cardiorespiratory fitness, increases exercise capacity, and enhances quality of life. Physical activity can lead to favorable heart changes and improve muscle function.
Achieving and maintaining a healthy weight is another important non-pharmacological strategy. Weight loss directly addresses a major contributor to HFpEF and can alleviate symptoms. This involves dietary changes and regular exercise.
General health recommendations, such as smoking cessation and moderation of alcohol consumption, also contribute positively to overall cardiovascular health and HFpEF management. These lifestyle changes reduce additional stress on the heart and vascular system.
Patients with HFpEF are encouraged to monitor their symptoms, including daily weight checks for fluid retention. Promptly reporting changes to their healthcare team allows for timely treatment adjustments. Patient education on their condition, medications, and self-management empowers individuals to improve quality of life and reduce hospitalizations.