The Curbsiders Internal Medicine Podcast

REBOOT: #460 Heart Failure with Preserved Ejection Fraction

36 snips
Sep 29, 2025
In this insightful discussion, Dr. Michelle Kittleson, a leading expert in heart failure at Cedars-Sinai, unpacks the complexities of heart failure with preserved ejection fraction (HFpEF). She explores key diagnostic strategies like the H2F-PEF score and the challenges of interpreting BNP levels in obese patients. The conversation also highlights the benefits of weight loss and supervised exercise, the role of SGLT2 inhibitors, and nuances in managing comorbidities. Dr. Kittleson provides practical tips for identifying when to refer patients, making this a must-listen for healthcare professionals.
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INSIGHT

HFpEF Has No Single Smoking Gun

  • HFpEF lacks a single 'smoking gun' unlike HFrEF and requires reasoning from symptoms to organ-level causes.
  • Think broadly about cardiac, pulmonary, vascular and systemic causes of dyspnea and edema before concluding HFpEF.
ADVICE

Use H2F‑PEF Score As A Practical Screen

  • Use the H2F-PEF score to estimate probability using readily available clinical and echo variables.
  • Interpret the score alongside pre-test probability and don't rely on it alone.
ADVICE

Always Consider Cardiac Amyloidosis

  • Always screen for cardiac amyloidosis when HFpEF is suspected because it changes therapy and prognosis.
  • Do not let a positive HFpEF score prevent targeted amyloid evaluation.
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