Heart failure with preserved ejection fraction (HFpEF) is a common and debilitating condition. It accounts for 50% of heart failure patients globally and is associated with high hospitalization and mortality rate. 60% of patients with HFpEF are women, typically post-menopausal. Loss of estrogen at menopause may have adverse effects on the heart muscles, increasing the risk of HFpEF.

What is heart failure with preserved ejection fraction (HFpEF)?

In HFpEF, the main pumping chamber of the heart (left ventricle) is stiff and is unable to relax normally between each heartbeat even though it can contract and pump relatively normal. This results in abnormal filling and high pressure in the left ventricle affecting the amount of blood the heart can pump to the rest of the body.

Who are at risk and what are the conditions associated with HFpEF?

  • Older age
  • Female
  • Hypertension
  • Diabetes mellitus
  • Obesity
  • Renal impairment
  • Atrial fibrillation

Symptoms of HFpEF

Symptoms of HFpEF include shortness of breath, reduced exercise tolerance, lower limbs and abdominal swelling. Symptoms are similar to its more well-known counterpart, heart failure with reduced ejection fraction (HFrEF), although patients with HFpEF often have non-specific symptoms such as generalized fatigue.

How can HFpEF be diagnosed?

Diagnosis of HFpEF is made when a person has symptoms and signs of heart failure but the left ventricle ejection fraction (a measurement of the heart pump function) is preserved (50% or more). Transthoracic echocardiography scan is commonly performed to assess the heart function and can demonstrate objective evidence of structural and/or functional abnormalities of the heart consistent with abnormal left ventricle diastolic function (inability of the heart to relax normally).

The diagnosis of HFpEF remains challenging. Symptoms of HFpEF can be mild and non-specific and commonly overlaps with other medical conditions such as lung disease. Commonly used modalities to evaluate the diastole function of the heart lack sensitivity. As such, HFpEF tends to be underdiagnosed.

What is the treatment for HFpEF?

Unlike HFrEF, there are no established medications effective for treatment of HFpEF. Treatment is targeted at managing the associated medical conditions and to optimize control of risk factors. There is recent emergence of potential medication for HFpEF which was shown to reduce hospitalization frequency and improve quality of life of patients with HFpEF.

Can HFpEF be prevented?

Chances of getting HFpEF can be reduced by maintaining a heart healthy lifestyle (including regular exercise, heart healthy diet, stop smoking and keep an optimal weight) to optimize modifiable risks. This would reduce risks of getting hypertension, diabetes, obesity and helps to prevent HFpEF as much as possible.