220. Little Room for Relaxation- Heart Failure Preserved Ejection Fraction
Jan 14, 2024
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This podcast discusses heart failure preserved ejection fraction (HFpEF), its diagnosis, comorbid conditions, and physical examination findings. It also explores the management options, challenges, and limited therapeutic recommendations for improving outcomes. Additionally, it highlights the results of two randomized trials studying the impact of SGL-II inhibitors on heart failure with preserved ejection fraction.
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Quick takeaways
HFpEF is a prevalent type of heart failure characterized by diastolic dysfunction and normal ejection fraction.
SGLT2 inhibitors, such as empagliflozin and dapagliflozin, have shown significant reductions in heart failure hospitalizations in patients with HFpEF.
Deep dives
Understanding Heart Failure with Preserved Ejection Fraction
Heart failure with preserved ejection fraction (HFpEF) is a prevalent and growing global pandemic, characterized by diastolic dysfunction and normal ejection fraction. Risk factors for developing HFpEF include aging, hypertension, coronary artery disease, diabetes, obesity, and valvular heart disease. Symptoms of HFpEF include dyspnea on exertion, orthopnea, and paroxysmal nocturnal dyspnea, with fatigue being a common complaint. Diagnosis involves a thorough history, physical examination, chest x-ray, ECG, BNP level, and echocardiogram.
Management of Heart Failure with Preserved Ejection Fraction
The management of HFpEF focuses on treating underlying causes, managing comorbid conditions, and symptom management. Lifestyle modifications such as salt restriction, physical activity, medication adherence, and vaccinations are recommended. Optimal control of cardiovascular comorbidities like hypertension, diabetes, and obesity is crucial. Mineral corticoid receptor antagonists (MRAs) and SGLT2 inhibitors have shown promise in improving outcomes, while ACE inhibitors or ARBs may reduce heart failure hospitalizations. Loop diuretics can be used for symptom relief, but no mortality benefit has been observed.
SGLT2 Inhibitors in Heart Failure with Preserved Ejection Fraction
Sodium glucose co-transporter II (SGLT2) inhibitors, such as empagliflozin and dapagliflozin, have shown significant reductions in heart failure hospitalizations in patients with HFpEF. The EMPEROR-Preserved and DELIVER trials demonstrated the efficacy of SGLT2 inhibitors in reducing cardiovascular death and heart failure hospitalization. The latest AHA guidelines recommend the use of SGLT2 inhibitors to reduce heart failure morbidity and hospitalizations in patients with HFpEF.
HFpEF is the lesser talked about, but still equally important type of CHF! We discuss the evidence and give you a run-down on everything you need to know about HFpEF. Written by Dr. Aishwarya Roshan, Internal Medicine resident, and reviewed by Dr. Krishnan Ramanathan, Cardiology and CICU, and Dr. Alison Lai, Internal Medicine. Infographic by Dr. Caitlyn Vlasschaert, Internal Medicine Resident.