Treatment of heart failure with preserved systolic function in the elderly

Heart failure with preserved systolic function (HF-PSF) may account for 50% or more of patients with heart failure, occurring more commonly in the elderly with comorbid conditions such as hypertension, diabetes, obesity and coronary artery disease. HF-PSF is associated with high morbidity and mortality. A recent study demonstrated that, although survival improved significantly over time among heart failure patients with reduced ejection fraction, there was no such trend toward improvement among patients with HF-PSF. There exists an urgent need to develop effective treatment strategies, specifically for patients with HF-PSF. Current therapeutic recommendations for HF-PSF are aimed at the symptomatic management as well as the treatment of concomitant comorbidities, including hypertension, atrial fibrillation and myocardial ischemia. In spite of two large, recent studies evaluating therapies for HF-PSF, no specific strategies have been proven to substantially benefit outcomes in patients with HF-PSF. This review evaluates the development of therapeutic strategies for HF-PSF and provides an overview of recently completed and currently ongoing clinical trials in patients with HF-PSF, as well as possible therapeutic targets for future study.