Heart failure with preserved ejection fraction

Clinicians are advised to:

• Monitor blood pressure as closely as necessary to meet targets based on the latest guidelines and to avoid symptomatic postural hypotension[157]James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014 Feb 5;311(5):507-20. http://jamanetwork.com/journals/jama/fullarticle/1791497 http://www.ncbi.nlm.nih.gov/pubmed/24352797?tool=bestpractice.com [158]Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. J Am Coll Cardiol. 2018 May 15;71(19):e127-248. http://www.onlinejacc.org/content/71/19/e127 http://www.ncbi.nlm.nih.gov/pubmed/29146535?tool=bestpractice.com [159]Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018 Sep 1;39(33):3021-104. https://www.doi.org/10.1093/eurheartj/ehy339 http://www.ncbi.nlm.nih.gov/pubmed/30165516?tool=bestpractice.com [160]National Institute for Health and Care Excellence. Hypertension in adults: diagnosis and management. Nov 2023 [internet publication]. https://www.nice.org.uk/guidance/ng136

• Monitor volume status (daily weights and adjustment of diuretic dose as necessary)

• Screen for common comorbidities:

  • Screen for diabetes annually; if the patient is diabetic, strict glucose control with hemoglobin A1c every 3 to 6 months should be performed

  • Screen for coronary artery disease when appropriate

  • Screen for sleep apnea when appropriate

  • Screen for chronic kidney disease.

Patients benefit from frequent formal evaluation in a specialized center or monitoring in a management program.[3]Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation. 2022 May 3;145(18):e895-1032. https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000001063 http://www.ncbi.nlm.nih.gov/pubmed/35363499?tool=bestpractice.com ​ Assessment should be made at each visit of the ability of a patient to perform routine and desired activities of daily living. Assessment should be also made of the fluid status and weight of the patient. Careful history of current use of alcohol, tobacco, illicit drugs, alternative therapies, and chemotherapy drugs, as well as diet and sodium intake, should be obtained at each visit.[161]Chow SL, Bozkurt B, Baker WL, et al. Complementary and alternative medicines in the management of heart failure: a scientific statement from the American Heart Association. Circulation. 2023 Jan 10;147(2):e4-e30. https://www.doi.org/10.1161/CIR.0000000000001110 http://www.ncbi.nlm.nih.gov/pubmed/36475715?tool=bestpractice.com ​ Repeat measurement of ejection fraction and assessment of the severity of structural remodeling can provide useful information in patients with heart failure who have had a change in clinical status, or who have experienced or recovered from a clinical event.