Heart Failure Without a Reduced Ejection Fraction

Heart failure (HF) substantially impacts the health and financial security of an increasing proportion of the US population. It worsens debility and quality of life and may lead to hospitalization and death. HF is a clinical syndrome with diverse symptomatic presentations. Physicians generally divide patients with HF into 2 groups: those with a left ventricular ejection fraction (LVEF) greater than or equal to 50% and those with an LVEF less than 49%. This review focuses on the group of patients whose LVEF is greater than or equal to 50%. This classification of HF is referred to as HF with a preserved ejection fraction (HFpEF). Few beneficial therapies have been identified for this condition, possibly because of its heterogenous etiologies (eg, myocardial, vascular, metabolic, and other physiologic derangements). Clinicians should focus on diagnosing, treating, and preventing the etiologies that are known to cause HFpEF. Results from a small proportion of randomized controlled trials have shown therapeutic benefit for small molecules, although limited, if any, demonstrated mortality benefit has been noted. More research and investment are needed to decrease the burden of HFpEF and to discover lifesaving treatments for this growing population.