Heart failure with preserved ejection fraction: update on diagnosis and therapy

Heart failure with preserved ejection fraction (>= 50%, HFpEF) has a high prevalence, affecting approximately 50% of patients with heart failure, for which no effective medication exists as yet, as no drug therapy was successful in improving survival. HFpEF is a syndrome that in its classical form is associated with multiple risk factors and comorbidities, which confer an extreme heterogeneity characterizing HFpEF. In addition to the clinical presentation, also the pathophysiological mechanisms are multiple. Altogether, these aspects largely account for the diagnostic challenges and the lack of a comprehensive treatment strategy in HFpEF patients. A more personalized medicine approach is therefore needed, aimed at treating specific patient subsets, with therapies that in several HFpEF phenotypes proved to be effective in reducing morbidity and improving surrogate outcomes, including quality of life.