HFpEF at a Turning Point: From Limited Therapies to Precision-Based Management

Heart failure with preserved ejection fraction (HFpEF) is the cause of over fifty percent of all cases of heart failure, given its rising prevalence, particularly in old age, with numerous comorbidities. In modern studies, the concept of HFpEF has been broadened to encompass numerous symptoms associated with inflammation, microvascular and endothelial dysfunction, myocardial rigidity, and decreased cardiovascular reserve, as opposed to its historic emphasis on the phenomenon of diastolic dysfunction. The necessity to enhance the imaging, exercise testing, and the biomarker-based assessment is supported by the statement that the currently existing diagnostic algorithms demonstrate low levels of accuracy when applied to diverse groups of patients. New phenotyping and precision medicine approaches are also attempting to sub-categorize patients with distinct biological characteristics and subsequently match them with a specific treatment in order to address HFpEF heterogeneity. Recent transformations in the treatment landscape in the form of sodium-glucose cotransporter-2 inhibitors and novel metabolic, anti-fibrotic, anti-inflammatory, and device-based treatment have introduced a new approach to HFpEF care based on phenotype.