Approach to the Treatment of Heart Failure With Preserved Ejection Fraction and Mid- Range Ejection Fraction

Abstract

In this article we discuss the treatment of heart failure (HF) with preserved ejection fraction (HFpEF) and of HF with mid-range ejection fraction (HFmrEF) as has received considerable interest since the publciation of the 2016 European Society of Cardiology (ESC) heart failure guidelines. Since clinical trials on HFpEF have included also patients with HFmrEF, due to the lack of an agreed definition, the ESC recommendations here described apply to both phenotypes. As a consequence of the recent characterisation of this HF syndrome, it is expected that upcoming research will provide data specifically regarding HFmrEF and tailored recommendations will be developed in the future.

Frailty in patients with heart failure

“…Heart failure (HF) is one of the most important and rapidly growing diseases due to its high prevalence worldwide and the significant impact on morbidity and mortality 1–4 . The phenotype of patients with HF is often complex because of their improved survival from other chronic conditions and the progressive aging of developed societies, 5 leading to an increased prevalence in particular if heart failure with preserved ejection fraction (HFpEF) in the elderly 6 , 7 . The typical patient with HF presents with an involvement and impairment of multiple organs and body systems that require complex and intricate poly-therapeutic schemes 8 .…”

Drug therapy in elderly heart failure patients

“…Therefore, the pharmacotherapy of HFrEF in elderly patients is recommended to be the same as for patients in all other age groups according to the ESC/HFA guidelines, 2 and is based on ACE inhibitors (or angiotensin receptor antagonists [ARB] or angiotensin receptor-neprilysin inhibitors [ARNI]), beta-blockers, mineralocorticoid receptors (MRA), ivabradine to improve clinical outcomes, along with loop diuretics, and sometimes digoxin to further alleviate HF symptoms 16 , 17 …”