Disease Description (Causes and Symptoms)
- Definition: Heart failure with preserved ejection fraction (HFpEF) is diagnosed when there are symptoms and signs of heart failure, left ventricular ejection fraction (LVEF) ≥ 50%, and objective evidence suggesting elevated natriuretic peptides (BNP/NT‑proBNP) or left ventricular diastolic dysfunction/elevated filling pressure. As supportive diagnostic findings, invasive hemodynamic testing may show pulmonary capillary wedge pressure (PCWP) ≥ 15 mmHg (at rest) or ≥ 25 mmHg (during exercise), or left ventricular end-diastolic pressure (LVEDP) ≥ 16 mmHg.
- Pathophysiology: Inability of the left ventricle to relax (reduced compliance and impaired expansion) and increased cardiac filling pressure → pulmonary congestion and dyspnea during exercise. Left ventricular hypertrophy and fibrosis, left atrial enlargement, vascular and endothelial dysfunction, and systemic inflammation and metabolic diseases are associated.
- Major causes and comorbidities: Hypertension, atrial fibrillation, ischemic heart disease, diabetes, obesity, chronic kidney disease, lung disease, anemia, etc.
- Major symptoms: Dyspnea during activity (exercise), fatigue, reduced exercise tolerance, orthopnea and paroxysmal nocturnal dyspnea (as the condition progresses), edema and weight gain, and palpitations due to arrhythmia.
Treatment Methods and Precautions
- Goals: Relieve symptoms, prevent acute exacerbations, treat comorbidities, and improve quality of life.
- Drug treatment (reflecting recent evidence):
- SGLT2 inhibitors (e.g., empagliflozin, dapagliflozin): Recommended because benefits such as reduced hospitalization have been demonstrated in HFpEF.
- Diuretics: Relieve symptoms of congestion (fluid overload) (monitoring of kidney function and electrolytes is required).
- Blood pressure control (ACE inhibitors/ARBs/calcium channel blockers, etc.): Strong control is important when hypertension is present (improves the course of heart failure).
- Treatment of atrial fibrillation (rate and rhythm control, anticoagulation): Affects symptoms and prognosis.
- In selected cases: Mineralocorticoid receptor antagonists (MRAs, e.g., spironolactone) or ARNIs (e.g., sacubitril/valsartan) may be helpful in some patients; consider the risks and benefits for each individual patient.
- Non-drug treatment:
- Assessment-based weight loss (for patients with obesity), regular aerobic exercise, and cardiac rehabilitation (improve exercise capacity).
- Limit salt intake (individualized), quit smoking, and control alcohol consumption.
- Active management of comorbidities (diabetes, anemia, lung disease, kidney failure, etc.).
- Interventional/surgical treatment:
- In most cases, specific procedures are not standard treatment and are performed when indicated according to the underlying disease (such as severe coronary artery disease or valvular disease).
- Precautions / risk of complications / self-management considerations:
- Be cautious of hypotension, worsening kidney function, and hypokalemia caused by excessive diuresis.
- When using SGLT2 inhibitors, monitor for genitourinary infections and the possibility of rare acute changes in kidney function.
- Contact a healthcare professional promptly if heart failure worsens (increased shortness of breath, rapid weight gain, hypoxemia, etc.).
- Regular monitoring of weight, blood pressure, and symptoms, as well as kidney function and electrolyte testing, is necessary.
Checklist Before an Outpatient Visit (Items to Prepare · Things to Check)
- Items/documents to bring:
- A list of currently used medications (including prescription drugs, over-the-counter medicines, and supplements)
- Recent echocardiogram findings, BNP/NT‑proBNP test results, electrocardiogram (ECG), and recent blood test results (kidney function and electrolytes)
- Records of recent weight changes (daily weight records are ideal, if available), and records of when symptoms started, their type, and aggravating factors
- Things to check in advance for the outpatient visit:
- Frequency and type of recent shortness of breath (during exercise/at rest/at night), and changes in exercise capacity
- Edema (legs/abdomen), changes in nighttime urination, and whether dizziness or fainting is present
- Current blood pressure and heart rate (including measurements taken at home)
- Comorbidities such as kidney disease, diabetes, and lung disease, and a history of heart surgery or interventional procedures
- Example questions (items to check with the doctor in advance):
- Do any of my current medications need to be stopped or adjusted?
- How often should kidney function and electrolyte tests be performed?
Examples of General Questions to Ask the Doctor
- What are the expected effects and possible side effects of this medication?
- What is my prognosis (risk of readmission and death)?
- How should management of comorbidities such as blood pressure, diabetes, and atrial fibrillation be optimized?
- What exercise and weight-management recommendations (intensity, frequency, and goals) apply to me?
- What symptoms require me to come to the hospital immediately if the disease worsens?
Examples of Disease-Specific Questions
- My ejection fraction is 50% or higher on echocardiography, but my BNP level is normal. What additional tests are needed (exercise stress testing, invasive hemodynamic testing, etc.)?
- I have atrial fibrillation. How do heart rate control and anticoagulation treatment affect the prognosis of HFpEF, and is an attempt at rhythm conversion (electrical or medication-based) recommended?
(Note: Diagnostic and treatment decisions should be made in consultation with the treating healthcare professionals based on the individual patient's clinical situation and the latest clinical guidelines.)