Table 1.

Management of Heart Failure with Preserved Ejection Fraction (HFpEF) by Phenotypic Classification

Phenotypic Classification	Management Strategies
Garden-variety HFpEF	• Treat comorbidities
	• Enroll in HFpEF clinical trial
Coronary artery disease-HFpEF	• Consider revascularization
	• Aggressive medical management of coronary artery disease
Right heart failure-predominant HFpEF	• Diuresis/ultrafiltration
	• Digoxin (dose qMWF if elderly and/or if CKD is present)
	• Midodrine to support systemic blood pressure if systemically hypotensive
	• PDE5 inhibition if superimposed pulmonary arterial hypertension is present (i.e., if PA diastolic pressure – pulmonary capillary wedge pressure > 5 mmHg)
Atrial fibrillation-predominant HFpEF	• Typically require rate/rhythm control more than anti-hypertensive therapy
	• Trial of cardioversion or ablation, especially if very symptomatic loss of atrial contraction
	• Anticoagulation unless contraindicated
Hypertrophic cardiomyopathy-like HFpEF	• Verapamil, diltiazem, long-acting metoprolol; cautious use of diuretics and vasodilators (use only if absolutely necessary)
Valvular HFpEF	• Medical treatment of underlying valve disease if possible
	• Surgical treatment of valvular disease if indicated
High output HFpEF	• Determine underlying cause of high output state (i.e., anemia, liver disease, AV fistula, hyperthyroidism)
	• Treat underlying cause of high output state
	• Diuretics/ultrafiltration typically necessary
Rare causes of HFpEF (“zebras”)	• Determine underlying etiology
	• Treat underlying cause
	• Enroll in clinical trial if possible

HFpEF—heart failure with preserved ejection fraction; qMWF—every Monday, Wednesday, and Friday; GFR—glomerular filtration rate; PDE5—phosphodiesterase-5 inhibitor; PA—pulmonary artery; LVEDP—LV end-diastolic pressure; AV—arteriovenous.

From Oktay AA, Shah SJ. Diagnosis and Management of Heart Failure with Preserved Ejection Fraction: 10 Key Lessons. Curr Cardiol Rev 2013; with permission.