Advances in the treatment of heart failure with a preserved ejection fraction

PURPOSE OF REVIEW: Heart failure with preserved ejection fraction (HF-PEF) occurs in approximately 50% of patients with heart failure (HF) and is associated with high morbidity and mortality. A recent study demonstrated that, although survival improved significantly over time among HF patients with reduced ejection fraction (EF), there was no such trend toward improvement among patients with HF-PEF. Therefore, there exists an urgent need to develop effective treatment strategies specifically for patients with HF-PEF. Recently completed and ongoing research in the treatment of HF-PEF is reviewed in this article. RECENT FINDINGS: The two large randomized clinical trials completed in HF-PEF patients did not achieve statistical significance in benefit of renin-angiotensin system blockade on their primary combined endpoints of morbidity and mortality. Both trials, however, suggested the benefit of the angiotensin receptor and angiotensin-converting enzyme blockade on HF hospitalization. In addition, no clear benefit of β-blockers has been demonstrated specifically in patients with HF-PEF. SUMMARY: Current therapeutic recommendations for HF-PEF are aimed mostly at symptomatic management and treatment of concomitant comorbidities. Results of ongoing clinical trials further evaluating inhibition of the angiotensin and the aldosterone receptors as well as examining other novel therapeutic targets in HF-PEF are keenly awaited.