Heart Failure with Preserved Ejection Fraction: A Clinical Reappraisal

Abstract

Heart failure with preserved ejection fraction (HFpEF) poses a significant and growing clinical burden, yet its complex pathophysiology and diagnostic challenges hinder effective management, necessitating a comprehensive reappraisal of current knowledge. This review highlights the heterogeneous nature of HFpEF, emphasizing the critical roles of comorbidities such as hypertension, diabetes, and obesity in driving disease progression, while also exploring advancements in diagnostic tools like the HFA-PEFF score and emerging biomarkers. Furthermore, it evaluates the therapeutic potential of SGLT2 inhibitors, anti-inflammatory agents, and personalized treatment strategies, offering insights into their mechanisms and clinical benefits. The review underscores the limitations of current therapies and the need for improved phenotyping to guide precision medicine approaches. Future research should prioritize large-scale trials to validate novel interventions, refine diagnostic criteria, and explore integrative care models that address both cardiac and systemic contributors to HFpEF. By bridging gaps in understanding and treatment, this review aims to inform clinical practice and inspire innovative solutions for improving outcomes in HFpEF patients.