Treatment of heart failure with preserved ejection fraction

Heart failure, in its diverse forms based on the value of the ejection fraction, is associated to high mortality and the frequent need for hospitalization, with a consequent heavy burden on healthcare resources. For an appropriate treatment of heart failure with preserved ejection fraction (HFpEF), there are no specific drugs effective for this condition. Those indicated in HF with reduced EF (HFrEF) are of more benefit in that form of HF, according to the guidelines of the European Society of Cardiology of 2016: ACE-inhibitors, beta-blockers, anti-aldosterones are all indicated with a class of recommendation/level of evidence IA; therapy with loop diuretics is indicated in the case of clinical congestion (IB). Studies carried out with ACE-inhibitor (or angiotensin-receptor antagonist) or beta-blocker or anti-aldosterone to evaluate their efficacy also in HFpEF have substantially shown a benefit only on a reduction in the hospitalization rate. The same guidelines identify regular aerobic activity (IA) as more effective in the condition of HFpEF and indicate, appropriately, the need to treat comorbidities (IC) in the elderly (where they are more present and more numerous). They also recommend to avoid certain associations of drugs and, obviously, harmful (and contraindicated) medications that could worsen the clinical picture or might be potentially lethal.