Table 1.

Clinical Synopsis

HFpEF is currently the most common form of HF, particularly in women, and is nearly unique to the older population HFpEF meets all the criteria for a true geriatric syndrome. The pathophysiology of HFpEF is complex and incompletely understood, but is likely multi-factorial, systemic in nature, with contribution from underlying age-related changes and frequent multiple chronic co-morbidities, and multi-organ involvement, and significant clinical heterogeneity. Multiple non-cardiac co-morbidities are strong contributors to exercise intolerance in chronic HFpEF, and to the high rate of clinical events, including hospitalizations and death. Other than diuretics to ameliorate volume overload, medication treatments tested to date have been relatively ineffective. Diuretic adjustments can be performed as needed by nurses over the telephone, and in some cases by patients themselves. Every HF patient should have a scale, weigh regularly, and know what steps to take if weight increases beyond pre-specified ranges. Frequent follow-up appointments and periodic telephone calls can be helpful Exercise training and dietary weight loss can improve symptoms, exercise capacity, and quality of life in HFpEF Preventive measures include: Optimal control of systolic HTN, regular moderate physical activity, prevention and treatment of obesity, and management of comorbidities, including diabetes, atrial fibrillation, lung disease, sleep apnea and anemia.

HFpEF=heart failure with preserved ejection fraction; HF=heart failure; HTN=hypertension