Patient phenotype profiling in heart failure with preserved ejection fraction to guide therapeutic decision making. A scientific statement of the Heart Failure Association, the European Heart Rhythm Association of the European Society of Cardiology, and the European Society of Hypertension

Abstract

Heart failure with preserved ejection fraction (HFpEF) represents a highly heterogeneous clinical syndrome affected in its development and progression by many comorbidities. The left ventricular diastolic dysfunction may be a manifestation of various combinations of cardiovascular, metabolic, pulmonary, renal, and geriatric conditions. Thus, in addition to treatment with sodium–glucose cotransporter 2 inhibitors in all patients, the most effective method of improving clinical outcomes may be therapy tailored to each patient's clinical profile. To better outline a phenotype‐based approach for the treatment of HFpEF, in this joint position paper, the Heart Failure Association of the European Society of Cardiology, the European Heart Rhythm Association and the European Hypertension Society, have developed an algorithm to identify the most common HFpEF phenotypes and identify the evidence‐based treatment strategy for each, while taking into account the complexities of multiple comorbidities and polypharmacy.

July 2023 at a glance: heart failure with preserved ejection fraction and comorbidities

“…Heart failure (HF) with preserved ejection fraction (HFpEF) is a heterogeneous syndrome 1–3 . A scientific statement from the Heart Failure Association (HFA) described most common HFpEF phenotypes, related comorbidities and treatment options for each phenotype 4 …”

“…1-3 A scientific statement from the Heart Failure Association (HFA) described most common HFpEF phenotypes, related comorbidities and treatment options for each phenotype. 4 Exercise testing has a key role in the diagnosis and prognostic assessment of HFpEF. 1,5,6 In a study by Alogna et al, 7 398 patients with HFpEF undergoing comprehensive echocardiography and invasive cardiopulmonary exercise testing were categorized low versus preserved biventricular cardiac power output (BCPO) reserve (< vs ≥ median of 1.57 W).…”

November 2023 at a glance: Focus on cardiogenic shock, post‐discharge outcomes and cardiomyopathies

“…10-13 Among them, obesity is common and may define a specific one. [10][11][12] Chin et al 14 showed that increased epicardial adipose tissue thickness is associated with subclinical cardiac dysfunction in subjects with severe obesity and no known history of cardiovascular (CV) disease, referred to bariatric surgery.…”

“…10-13 Among them, obesity is common and may define a specific one. [10][11][12] Chin et al 14 showed that increased epicardial adipose tissue thickness is associated with subclinical cardiac dysfunction in subjects with severe obesity and no known history of cardiovascular (CV) disease, referred to bariatric surgery.Degenerative aortic valve stenosis (AVS) with preserved ejection fraction (EF) might represent a specific sub-phenotype of HFpEF. In a prospective study, 148 patients with HFpEF, 150 patients with degenerative moderate-to-severe AVS with preserved EF and 66 age-and sex-matched healthy controls underwent functional capacity measurements.…”

Addressing comorbidities in heart failure: When feeling better and living longer go in the same direction

“…It may also explain why it may be difficult to improve quality of life using HF-targeted therapies alone, particularly in patients with HFpEF who have a higher burden of comorbidities. 26 Notably, the comorbidities associated with the highest impact on KCCQ scores, anaemia, angina, chronic obstructive pulmonary disease and obesity, in both HFrEF and HFpEF, are 'treatable' comorbidities, 27 demonstrating the potential of their treatment to improve health status in patients with HF.…”