Understanding Heart Failure with Preserved Ejection Fraction (HFpEF): A San Diego Cardiologist's Guide

When I tell patients they have heart failure, I can see the immediate concern in their eyes. The term "heart failure" sounds terrifying, like your heart is about to stop working completely. But I want to reassure you that heart failure with preserved ejection fraction (HFpEF) is something we can manage together, and understanding it is the first step toward living well with this condition.

HFpEF represents about half of all heart failure cases I see in my San Diego practice. Your heart muscle is still squeezing normally (that's what we mean by "preserved ejection fraction"), but it has trouble relaxing and filling with blood between beats. Think of it like a balloon that's become stiffer and harder to inflate, even though it can still squeeze out the air inside.

This condition affects millions of Americans, particularly women over 65, and it's becoming more common as our population ages. The good news is that we've made significant advances in understanding and treating HFpEF in recent years. While it requires ongoing management, most of my patients live full, active lives with the right treatment approach.

How HFpEF Affects Your Heart

To understand what's happening in your heart, let me explain how a healthy heart works first. Your heart has four chambers, and the main pumping chamber, the left ventricle, needs to do two things well: squeeze forcefully to pump blood out (systole) and relax completely to let blood flow in (diastole). In HFpEF, the squeezing function remains normal, but the relaxation phase becomes impaired.

When your left ventricle becomes stiffer, it can't fill with blood as easily as it should. This creates a backup of pressure that extends all the way back to your lungs, causing the shortness of breath you might be experiencing. The stiffness often develops gradually due to changes in the heart muscle itself. Tiny fibers called collagen build up between muscle cells, making the whole chamber less flexible.

Several factors contribute to this process. High blood pressure, which many of my patients have had for years, forces your heart to work harder and can lead to thickening and stiffening of the heart muscle. Diabetes affects the small blood vessels that nourish your heart muscle, while obesity and inflammation throughout your body can worsen the problem. Unlike other forms of heart failure where blocked arteries are often the culprit, HFpEF usually results from this combination of conditions working together over time.

The inflammation aspect is particularly interesting. Recent research shows that conditions like diabetes, obesity, and high blood pressure create a state of chronic inflammation throughout your body. This inflammation affects not just your heart, but also your blood vessels, kidneys, and even your skeletal muscles. That's why you might feel tired and weak beyond what the heart problem alone would explain.

What makes HFpEF especially challenging is that these changes often happen so gradually that your body adapts to them. You might not notice symptoms until the stiffness becomes severe enough to significantly impair your heart's ability to fill with blood, especially during physical activity when your heart needs to pump more blood to meet your body's demands.

Understanding Your Test Results

When I suspect HFpEF, several tests help me confirm the diagnosis and understand how your heart is functioning. The most common test is an echocardiogram, which uses sound waves to create moving pictures of your heart. This test shows me your ejection fraction, the percentage of blood your heart pumps out with each beat. In HFpEF, this number is 50% or higher, which is actually normal.

But the echocardiogram reveals much more than just ejection fraction. I look carefully at how your heart fills with blood between beats, measured by something called the E/e' ratio. When this ratio is 15 or higher, it usually indicates that the pressure inside your heart is elevated, which is a key finding in HFpEF. I also examine your left atrium, the chamber that receives blood from your lungs. When it's enlarged, it often means it's been working harder to push blood into a stiff left ventricle.

Here's something important to understand: finding diastolic dysfunction on your echocardiogram doesn't automatically mean you have HFpEF. Diastolic dysfunction simply indicates that your heart muscle isn't relaxing normally between beats. Many people have this finding on their echo without having any symptoms or heart failure. For a true HFpEF diagnosis, I need to see both the heart changes AND symptoms like shortness of breath or swelling that are actually caused by those heart changes.

This distinction is crucial because it affects your treatment and prognosis. If you have diastolic dysfunction but no symptoms, you might not need heart failure medications, but we'll work hard to prevent progression by controlling your blood pressure and other risk factors. If you have symptomatic HFpEF, we'll add specific treatments to improve how you feel and prevent future complications.

Natriuretic peptides are hormones your heart releases when it's under stress. Blood tests measuring BNP or NT-proBNP can help support the diagnosis, though these aren't perfect. If you're overweight, these levels might be lower than expected even when you have heart failure. Conversely, if you have kidney problems or atrial fibrillation, the levels might be elevated for reasons other than heart failure.

Sometimes I use diagnostic scoring systems like the H2FPEF score or HFA-PEFF score. These tools combine your age, body mass index, atrial fibrillation status, blood pressure medications, echocardiogram findings, and lab results to estimate the likelihood that your symptoms are due to HFpEF. A high score makes the diagnosis more likely, while a low score suggests we should look for other causes of your symptoms.

In cases where the diagnosis remains unclear after these initial tests, I might recommend a cardiopulmonary exercise test. This involves exercising on a treadmill while we monitor your heart rhythm, blood pressure, and breathing. Sometimes the heart's limitations only become apparent during physical stress, when the demand for blood flow increases.

Occasionally, I need to perform right heart catheterization, especially if other tests are inconclusive. This involves threading a thin tube through a vein to measure pressures directly inside your heart. While this might sound intimidating, it's actually quite safe and provides the most accurate assessment of your heart's filling pressures, particularly during exercise.

Who Develops HFpEF

In my practice, I see certain patterns in who develops HFpEF. The typical patient is a woman over 65 with several other health conditions. This differs from the other main type of heart failure, where blocked arteries are more common and patients are often younger men.

Age plays a significant role because the heart naturally becomes stiffer over time. The proteins that give your heart muscle its structure change with age, becoming less flexible. When you combine this natural aging process with other conditions like high blood pressure and diabetes, the risk of developing HFpEF increases substantially.

Women are affected more often than men, possibly due to hormonal changes after menopause. Estrogen appears to help keep blood vessels flexible and may protect against inflammation. When estrogen levels drop, women may become more susceptible to the processes that lead to HFpEF.

High blood pressure is present in about 90% of my HFpEF patients. Years of elevated pressure force your heart to work harder, eventually leading to thickening and stiffening of the heart muscle. Even if we get your blood pressure under control, some of these changes may persist.

Obesity contributes to HFpEF in multiple ways. Excess weight increases the volume of blood your heart must pump and creates inflammation throughout your body. The fat tissue itself produces substances that can worsen heart function. Many of my patients find that losing weight, even modest amounts, can significantly improve their symptoms.

Diabetes affects the small blood vessels that nourish your heart muscle and contributes to inflammation and stiffening. Atrial fibrillation, the irregular heart rhythm, is both a cause and consequence of HFpEF. The irregular rhythm makes it harder for your heart to fill properly, while the underlying heart stiffness makes atrial fibrillation more likely to develop.

Sleep apnea is increasingly recognized as a contributor to HFpEF. The repeated episodes of low oxygen during sleep stress your cardiovascular system and can worsen heart function over time. If you snore loudly or your partner notices you stop breathing during sleep, it's worth discussing with me.

Making Treatment Decisions Based on Your Results

Once we've confirmed your HFpEF diagnosis, the approach to treatment depends on several factors: the severity of your symptoms, your other medical conditions, and what's causing the heart stiffness in your particular case. Unlike other forms of heart failure where we have many proven medications, treatment for HFpEF focuses more on managing symptoms and treating the conditions that contribute to the problem.

The most exciting development in HFpEF treatment has been SGLT2 inhibitors like dapagliflozin and empagliflozin. Originally developed for diabetes, these medications have proven benefits for heart failure patients whether or not they have diabetes. In large clinical trials, these drugs reduced hospitalizations and cardiovascular deaths by about 20%. They work by helping your kidneys remove excess salt and water, reducing inflammation, and improving how your heart uses energy. I now prescribe these for most of my HFpEF patients unless there's a specific reason they can't take them.

Diuretics remain essential for managing fluid buildup. When your heart can't fill properly, fluid backs up into your lungs and legs, causing shortness of breath and swelling. Diuretics help your kidneys remove this excess fluid, providing symptom relief. However, I have to be careful not to remove too much fluid, which can actually make symptoms worse by reducing the blood flow back to your heart.

Blood pressure control is critical. I aim for targets below 130/80 mmHg in most patients, using medications like ACE inhibitors, ARBs, or calcium channel blockers. Some patients worry about taking "too many" medications, but controlling blood pressure is one of the most important things we can do to prevent your HFpEF from worsening.

If you have atrial fibrillation, we need to address both the rhythm and the risk of stroke. Sometimes getting your heart rhythm back to normal can significantly improve your HFpEF symptoms. We also need to consider blood thinners to prevent strokes, though this decision involves weighing your stroke risk against bleeding risk.

Managing diabetes, if you have it, goes beyond just controlling blood sugar. Many diabetes medications, particularly SGLT2 inhibitors and GLP-1 agonists, have heart benefits that extend beyond their effects on blood sugar. Weight loss, which these medications can promote, often improves HFpEF symptoms significantly.

The timing of treatment adjustments depends on how you're feeling and what your tests show. If you're having more shortness of breath or leg swelling, we might need to adjust your diuretic dose quickly. Changes to other medications usually happen more gradually, allowing time to see the full effects and monitor for side effects.

Common Misconceptions About HFpEF

One of the biggest misconceptions I encounter is that HFpEF isn't "real" heart failure because your ejection fraction is normal. I've had patients told by well-meaning family members or even some healthcare providers that their heart is "fine" because it's still squeezing normally. This misunderstanding can be dangerous because it might lead you to ignore symptoms or avoid necessary treatment.

The truth is that HFpEF is absolutely real heart failure. Your symptoms are just as valid, and the condition can be just as serious as other forms of heart failure. The difference lies in what's going wrong with your heart, not in the severity or importance of the condition.

Another confusion I frequently address involves the difference between diastolic dysfunction and HFpEF itself. Many patients receive echocardiogram reports mentioning "diastolic dysfunction" and worry they have heart failure, while others are told they "only" have diastolic dysfunction and their symptoms aren't related to their heart. Both interpretations can be problematic.

Diastolic dysfunction simply means your heart muscle doesn't relax normally between beats. This is actually quite common, especially as we age or with conditions like high blood pressure and diabetes. Many people have diastolic dysfunction on their echocardiograms but feel perfectly fine and never develop heart failure symptoms. Think of it as your heart showing some wear and tear, like gray hair or reading glasses. These are common changes that don't necessarily cause problems.

HFpEF, on the other hand, is the full clinical syndrome where diastolic dysfunction combines with other problems to actually cause symptoms like shortness of breath, fatigue, and swelling. It's the difference between having some stiffness in your heart muscle (diastolic dysfunction) and that stiffness actually making you feel sick (HFpEF). You need both the heart changes AND the symptoms to have true HFpEF.

This distinction matters because it affects how we approach your care. If you have diastolic dysfunction but no symptoms, we focus on preventing progression by controlling blood pressure, managing diabetes, and maintaining a healthy weight. If you have full HFpEF with symptoms, we add treatments specifically aimed at improving how you feel and preventing hospitalizations.

Another common misconception is that heart failure means your heart is about to stop. The term "failure" is admittedly confusing and frightening. What we really mean is that your heart isn't working as efficiently as it should. Many of my patients live normal lifespans with appropriate treatment. It's a chronic condition that requires management, much like diabetes or high blood pressure.

Some patients believe that if their heart function appears normal on tests, they don't need to take medications or make lifestyle changes. This thinking can lead to worsening symptoms and potentially serious complications. The medications I prescribe and the lifestyle changes I recommend are based on proven benefits for people with HFpEF, regardless of how "normal" some of your test results might appear.

I also frequently hear the misconception that HFpEF only affects elderly people and that younger individuals don't need to worry about it. While it's true that HFpEF becomes more common with age, I've diagnosed it in patients in their 50s and even 40s, particularly those with diabetes, obesity, or poorly controlled high blood pressure.

There's also a persistent myth that nothing can be done for HFpEF because there aren't as many treatment options as for other types of heart failure. While it's true that we have fewer medications proven specifically for HFpEF, we absolutely can improve your symptoms and quality of life. The key is addressing all the contributing factors rather than looking for a single magic pill.

Some patients think that feeling short of breath with activity is just a normal part of aging and doesn't warrant medical attention. While some decline in exercise capacity is normal as we age, significant shortness of breath with routine activities like climbing stairs or walking a few blocks is not normal and should be evaluated.

What HFpEF Cannot Tell Us

While the diagnosis of HFpEF explains your current symptoms and guides treatment, there are important limitations to what this diagnosis can predict or determine. Understanding these limitations helps set realistic expectations and avoids unnecessary worry about unknowable futures.

HFpEF testing cannot predict exactly how your condition will progress over time. Some patients remain stable for years with minimal symptoms, while others experience gradual worsening despite optimal treatment. The course of the disease varies significantly from person to person, influenced by factors we can't always measure or predict.

We also can't determine from current tests whether your HFpEF will lead to other forms of heart failure. While most patients with HFpEF maintain their ejection fraction over time, some may develop reduced ejection fraction heart failure later. This transition is relatively uncommon and doesn't appear to be predictable based on current testing.

The tests we use to diagnose HFpEF can't tell us about every aspect of your heart's function. For example, your heart's ability to increase its output during exercise might be more impaired than resting tests suggest. This is why some patients feel much more limited during physical activity than their resting test results would predict.

Prognosis remains challenging to determine precisely. While we know that HFpEF carries risks similar to other forms of heart failure, I can't tell any individual patient exactly what their life expectancy will be. Too many factors influence outcomes, including your response to treatment, other health conditions, and lifestyle factors.

The underlying cause of your HFpEF isn't always clear, even after extensive testing. We might identify contributing factors like high blood pressure and diabetes, but the exact reason why some people develop HFpEF while others with similar conditions don't remains incompletely understood.

Current testing also can't determine optimal exercise levels for every individual. While we know exercise is generally beneficial for HFpEF patients, the specific type, intensity, and duration that would be best for you requires individualized assessment and sometimes trial and error.

Finally, we can't predict with certainty which treatments will work best for you personally. While clinical trials show average benefits from medications like SGLT2 inhibitors, individual responses vary. Some patients experience dramatic symptom improvement, while others see minimal benefit from the same treatment.

When NOT to Pursue Certain Treatments

There are specific situations where certain HFpEF treatments may not be appropriate or could potentially cause harm. Understanding when to avoid particular interventions is just as important as knowing when to use them.

SGLT2 inhibitors, despite their proven benefits, aren't suitable for everyone. If you have severe kidney disease with very low filtration rates, these medications may not be effective and could potentially worsen kidney function. Patients with a history of diabetic ketoacidosis or those taking insulin who have type 1 diabetes need special consideration, as SGLT2 inhibitors can increase the risk of a serious condition called ketoacidosis.

Aggressive diuretic use can be harmful in certain circumstances. If your blood pressure runs low or you have severe kidney disease, removing too much fluid with diuretics can worsen kidney function and actually make you feel worse. Some patients become overly focused on eliminating all fluid retention, but a small amount of swelling might be acceptable if aggressive diuretic use causes other problems.

Cardiac catheterization for diagnostic purposes isn't necessary in most HFpEF cases. If you have clear symptoms, typical risk factors, and characteristic findings on non-invasive tests, invasive testing usually doesn't change our treatment approach. The risks of invasive procedures, while small, aren't justified when the diagnosis is already clear.

Certain blood pressure medications might not be ideal if you have specific types of HFpEF. Patients with very thick heart muscle (hypertrophic cardiomyopathy) might actually feel worse with some medications that reduce the heart's filling. This is why careful evaluation of your specific type of heart problem is essential before starting treatment.

Exercise stress testing should be avoided if you're having unstable symptoms or severe shortness of breath at rest. Testing is meant to be safe, and pushing someone who's already struggling with minimal activity could be dangerous.

Overly aggressive blood pressure lowering can sometimes worsen HFpEF symptoms. While good blood pressure control is important, some patients feel worse if their pressure drops too low. This is particularly true for older patients or those who've had high blood pressure for many years.

Weight loss, while generally beneficial, should be approached cautiously in patients who are frail or have lost significant muscle mass. Rapid weight loss or extreme calorie restriction can worsen muscle wasting and make fatigue worse rather than better.

Managing Your Expectations and Emotions

Receiving a diagnosis of HFpEF often brings a mix of emotions: relief at finally having an explanation for your symptoms, fear about what it means for your future, and sometimes frustration that the condition isn't more easily treatable. These feelings are entirely normal and understandable.

Many patients experience grief over the loss of their previous energy levels and physical capabilities. It's natural to mourn the activities you can no longer do as easily or the spontaneity you might have lost. Allow yourself to feel these emotions rather than trying to push them away or feel guilty about having them.

Fear about the future is common, especially given the scary-sounding name "heart failure." I want you to know that while HFpEF is a serious condition, most of my patients continue to live fulfilling lives. Yes, you may need to make some adjustments and take medications regularly, but this doesn't mean your life is over or that you can't pursue the things that matter to you.

Some patients become frustrated with the gradual nature of improvement. Unlike conditions where surgery can provide immediate relief, HFpEF management involves slowly optimizing multiple factors. Medications might take weeks or months to show their full benefits. Weight loss and exercise conditioning happen gradually. This can be discouraging when you want to feel better right away.

It's important to celebrate small improvements rather than focusing only on returning to your previous baseline. If you can walk one more block than last month, or if you sleep better with less shortness of breath, these are meaningful victories worth acknowledging.

Family dynamics often change when someone is diagnosed with a chronic condition. Some family members may become overprotective, while others might not understand why you can't do everything you used to. Open communication about your limitations and needs can help, but it may take time for everyone to adjust.

Many patients worry about being a burden on their loved ones. While it's true that you might need more help with certain activities, remember that relationships involve mutual support. The people who care about you want to help, and accepting assistance when needed isn't a sign of weakness.

Depression and anxiety are common in people with heart failure, and they can actually worsen your physical symptoms. If you find yourself feeling persistently sad, hopeless, or anxious about your health, please discuss this with me. Treatment for these conditions can improve both your emotional well-being and your heart failure symptoms.

How HFpEF Fits Into Your Overall Healthcare

HFpEF rarely exists in isolation. Most of my patients have several other health conditions that both contribute to their heart failure and require ongoing management. Understanding how these conditions interact helps us provide the best possible care.

Your primary care physician plays a crucial role in managing the conditions that contribute to HFpEF. Regular monitoring of your blood pressure, blood sugar (if you have diabetes), and kidney function helps us adjust treatments before problems develop. Many of the day-to-day management decisions for HFpEF can be handled by your primary care team, with cardiology consultation when needed.

If you have diabetes, your endocrinologist and I work together to choose medications that benefit both your blood sugar and your heart. Some diabetes medications, particularly SGLT2 inhibitors and GLP-1 agonists, have proven heart benefits. Coordinating these treatments avoids duplication and maximizes benefits.

Sleep medicine specialists become important if you have sleep apnea, which is common in HFpEF patients. Treating sleep apnea can improve your heart function and energy levels. CPAP machines or other sleep apnea treatments often lead to noticeable improvement in heart failure symptoms.

Pulmonologists might be involved if we need to distinguish between shortness of breath from your heart versus lung problems. Some patients have both COPD and HFpEF, and treatments for one condition might affect the other. Careful coordination ensures we're addressing all causes of your breathing difficulties.

Nephrologists become part of your team if your kidney function declines significantly. The kidneys and heart work closely together, and problems with one often affect the other. Kidney specialists help us balance heart failure treatments with kidney protection.

Physical therapists and cardiac rehabilitation specialists can design exercise programs specifically for people with HFpEF. These programs are different from general fitness programs because they take into account your heart's limitations and focus on gradual, safe improvement.

Nutritionists help with weight management and dietary sodium restriction. Many patients find that working with a nutrition specialist provides practical strategies for making sustainable dietary changes rather than attempting drastic restrictions that are hard to maintain.

Mental health professionals are valuable team members, particularly early after diagnosis when adjustment can be challenging. Counselors who understand chronic medical conditions can provide strategies for coping with lifestyle changes and managing anxiety about your health.

Future Directions in HFpEF Treatment

The field of HFpEF research is rapidly evolving, and there are several promising developments on the horizon that may improve treatment options for patients like you. While I always caution against waiting for future treatments instead of optimizing current care, understanding what's being studied can provide hope and context for your condition.

GLP-1 receptor agonists, medications originally developed for diabetes and now used for weight loss, are being studied specifically for HFpEF. These medications promote weight loss, improve blood sugar control, and may have direct heart benefits. Early studies are promising, and larger trials are underway to determine if these medications should become standard HFpEF treatment.

Researchers are investigating new ways to target the inflammation that contributes to HFpEF. Some studies are examining whether medications that reduce specific inflammatory pathways can improve heart function and symptoms. While these approaches are still experimental, they represent a promising new direction based on our growing understanding of HFpEF's underlying mechanisms.

Gene therapy and stem cell therapy are being explored for various forms of heart disease, including HFpEF. These approaches are still in very early stages of research, but they hold potential for actually reversing some of the heart muscle changes that contribute to HFpEF rather than just managing symptoms.

New diagnostic techniques are being developed that might help us identify HFpEF earlier and better predict which treatments will work best for individual patients. Advanced imaging techniques and blood tests that measure specific biomarkers might allow for more personalized treatment approaches.

Device therapies are being studied for HFpEF patients. These include devices that can relieve pressure in the heart during episodes of fluid buildup and others that might improve the heart's filling by modifying its structure. While these approaches are still investigational, they offer hope for patients who don't respond adequately to medical therapy.

Researchers are also working to better understand the different subtypes of HFpEF. Not all patients with this condition have the same underlying problems, and future treatments may be tailored to specific HFpEF phenotypes. This personalized approach could lead to much more effective treatments for individual patients.

Artificial intelligence is being applied to HFpEF diagnosis and treatment. Computer programs that can analyze complex patterns in test results might help us identify the condition earlier and predict which treatments will be most effective for specific patients.

Clinical trials are testing combination approaches that target multiple aspects of HFpEF simultaneously. Rather than treating each contributing factor separately, these studies examine whether coordinated treatment of inflammation, metabolism, and heart function together produces better results than current approaches.

Making Informed Decisions About Your Care

Living well with HFpEF requires you to become an active participant in your healthcare decisions. This doesn't mean you need to become a medical expert, but understanding your options and communicating effectively with your healthcare team leads to better outcomes and greater satisfaction with your care.

When considering any new treatment, ask specific questions about what to expect. How long before you might notice improvement? What are the most common side effects, and how would we monitor for them? What happens if the treatment doesn't work as expected? Understanding these details helps you make informed choices and sets realistic expectations.

Keep track of your symptoms and how they change over time. Many patients find it helpful to note their energy levels, breathing difficulties, and ability to perform daily activities. This information helps me understand how well your treatments are working and when adjustments might be needed.

Understand the goals of each treatment. Some medications are meant to improve symptoms quickly, while others work to prevent future complications even if you don't feel different right away. Knowing these goals helps you evaluate whether treatments are working and stick with them even when benefits aren't immediately obvious.

Consider your personal values and priorities when making treatment decisions. Some patients prioritize symptom relief above all else, while others are more concerned about avoiding side effects or maintaining independence. There's no right or wrong approach, but being clear about your priorities helps guide decision-making.

Don't hesitate to seek second opinions for complex decisions, particularly if surgery or invasive procedures are being considered. Most physicians, myself included, support patients getting additional input on important medical decisions. A second opinion can either reassure you about your treatment plan or provide additional options to consider.

Prepare for medical appointments by writing down your questions beforehand. It's easy to forget important concerns when you're in the doctor's office, and having a written list ensures you address everything that's worrying you.

Bring a family member or friend to important appointments if possible. They can help you remember what was discussed and ask questions you might not think of. Having support also makes it easier to process complex medical information.

Be honest about your ability to follow recommended treatments. If cost is a concern, if you're having trouble remembering medications, or if lifestyle changes are particularly challenging, let me know. We can often find solutions, but only if we understand what barriers you're facing.

Living Wisely with HFpEF

HFpEF is a condition that requires ongoing attention, but it doesn't have to define your life or prevent you from pursuing what matters most to you. The key is learning to work with your heart's limitations while maintaining as much of your desired lifestyle as possible.

Think of managing HFpEF as learning to drive a car with different capabilities than you're used to. You might not be able to go as fast or climb hills as easily, but you can still reach your destinations. It requires some adjustments in how you plan your trips and perhaps taking different routes, but the journey continues.

The most successful patients I see are those who become partners in their care rather than passive recipients of treatment. They learn about their condition, track their symptoms, take medications consistently, and communicate openly about challenges they're facing. This active engagement leads to better outcomes and greater satisfaction with care.

Remember that improvement often happens gradually with HFpEF. Unlike conditions where surgery can provide immediate relief, heart failure management involves slowly optimizing multiple factors. Medications might take weeks or months to show their full benefits. Exercise conditioning happens over time. Weight loss, if needed, should be gradual and sustainable.

Focus on what you can control rather than worrying about unknowable futures. You can take your medications as prescribed, follow dietary recommendations, stay as active as safely possible, and maintain regular follow-up appointments. These actions have proven benefits, even though we can't predict exactly how your condition will evolve over time.

Stay connected with the people and activities that bring meaning to your life. You might need to modify how you participate in certain activities, but don't assume you have to give up everything you enjoy. Many of my patients find creative ways to continue pursuing their passions within their new physical limitations.

Finally, remember that medical knowledge about HFpEF continues to advance rapidly. The treatment options available today are significantly better than what we had even five years ago, and the research pipeline suggests continued improvements ahead. While it's important to optimize your current care rather than waiting for future breakthroughs, there are legitimate reasons for hope about continued advances in HFpEF treatment.

Your diagnosis of HFpEF marks the beginning of a new chapter in your health journey, but it's not the end of your story. With proper management, most patients live full, meaningful lives. The key is working together to optimize your treatment while maintaining the perspective that you are much more than your medical condition.

References

1. Heidenreich, Paul A., Bozkurt Biykem, Aguilar David, et al. "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines." Journal of the American College of Cardiology 79, no. 17 (2022): e263-e421.

2. Redfield, Margaret M., and Barry A. Borlaug. "Heart Failure With Preserved Ejection Fraction: A Review." JAMA 329, no. 10 (2023): 827-838.

3. Campbell, Patricia, Frank H. Rutten, Mark M. Lee, Nathaniel M. Hawkins, and Mark C. Petrie. "Heart Failure With Preserved Ejection Fraction: Everything the Clinician Needs to Know." The Lancet 403, no. 10431 (2024): 1083-1092.

4. Borlaug, Barry A., Kavita Sharma, Sanjiv J. Shah, and Jennifer E. Ho. "Heart Failure With Preserved Ejection Fraction: JACC Scientific Statement." Journal of the American College of Cardiology 81, no. 18 (2023): 1810-1834.

5. Nagueh, Sherif F. "Heart Failure With Preserved Ejection Fraction: Insights Into Diagnosis and Pathophysiology." Cardiovascular Research 117, no. 4 (2021): 999-1014.

6. Lam, Carolyn S.P., Adriaan A. Voors, Rudolf A. de Boer, Scott D. Solomon, and Dirk J. van Veldhuisen. "Heart Failure With Preserved Ejection Fraction: From Mechanisms to Therapies." European Heart Journal 39, no. 30 (2018): 2780-2792.

7. Gevaert, Andreas B., Ravi Kataria, Faiez Zannad, et al. "Heart Failure With Preserved Ejection Fraction: Recent Concepts in Diagnosis, Mechanisms and Management." Heart 108, no. 17 (2022): 1342-1350.

8. Abdin, Amr, Michael Böhm, Bahira Shahim, et al. "Heart Failure With Preserved Ejection Fraction Epidemiology, Pathophysiology, Diagnosis and Treatment Strategies." International Journal of Cardiology 412 (2024): 132304.

9. Kittleson, Melanie M., Garima S. Panjrath, Kiran Amancherla, et al. "2023 ACC Expert Consensus Decision Pathway on Management of Heart Failure With Preserved Ejection Fraction: A Report of the American College of Cardiology Solution Set Oversight Committee." Journal of the American College of Cardiology 81, no. 18 (2023): 1835-1878.

10. Redfield, Margaret M. "Heart Failure with Preserved Ejection Fraction." The New England Journal of Medicine 375, no. 19 (2016): 1868-1877.

11. Lam, Carolyn S.P., Greg D. Gamble, Lieng H. Ling, et al. "Mortality Associated With Heart Failure With Preserved vs. Reduced Ejection Fraction in a Prospective International Multi-Ethnic Cohort Study." European Heart Journal 39, no. 20 (2018): 1770-1780.

12. Weerts, Joep, Ane Barandiarán Aizpurua, Ravi B. Patel, et al. "A Simplified Approach for Diagnosing Heart Failure With Preserved Ejection Fraction by Assessing the Left Atrium and Natriuretic Peptides." European Journal of Heart Failure (2025): doi:10.1002/ejhf.3651.

Published on damianrasch.com The above information was composed by Dr. Damian Rasch, drawing on individual insight and bolstered by digital research and writing assistance. The information is for educational purposes only and does not constitute medical advice.