A Stepwise Guide to the Diagnosis and Treatment of Heart Failure With Preserved Ejection Fraction

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Heart failure with preserved ejection fraction (HFpEF) is a growing epidemic owing to an increasingly obese and aging patient population. Making the diagnosis of HFpEF is often challenging because patients frequently have multiple comorbidities and alternative reasons for dyspnea and exercise intolerance, symptoms that are hallmark to the disease. Additionally, a universal diagnostic algorithm and definition of HFpEF is lacking. The treatment of HFpEF has been equally challenging, as there remain exceedingly few therapies show to improve survival in HFpEF and thus management to date has focused on intensive optimization of HFpEF risk factors. In this review, we highlight a stepwise approach to the diagnosis and treatment of HFpEF including (1) how to establish a clinical diagnosis of HFpEF, (2) when to refer for invasive diagnostic testing, (3) current treatment approaches to HFpEF including pharmacologic, nonpharmacologic, and risk factor modification interventions, and (4) when to refer to a dedicated HFpEF center or advanced heart failure specialist. With this systematic stepwise approach to HFpEF diagnosis and management, we aim to improve accurate diagnosis of the disease as well as raise awareness of available therapeutic options for this challenging patient population.

Original languageEnglish (US)
Pages (from-to)1016-1030
Number of pages15
JournalJournal of cardiac failure
Issue number6
StatePublished - Jun 2022


  • Heart failure with preserved ejection fraction
  • exercise stress test
  • natriuretic peptides

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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