![]() ![]() No difference between groups in Minnesota Living with Heart Failure Questionnaire scores patients taking spironolactone had lower six-minute walk distance (517 vs. Digoxin should also be avoided in patients 65 years and older who have HFpEF.Īldosterone Receptor Blockade in Diastolic Heart Failure (Aldo-DHF) trial A1Ĥ22 patients with symptomatic HF and LVEF ≥ 50% The use of nitrates, spironolactone, and angiotensin receptor blockers should be avoided in patients with HFpEF. Hypertension in patients with HFpEF should be treated according to evidence-based hypertension treatment guidelines. Patients with HFpEF and coronary artery disease who have indications should be offered revascularization. ![]() ![]() Patients with HFpEF should be referred for endurance and resistance training. Patients with HFpEF who have signs and symptoms of fluid overload should be treated with diuretics. This includes those with elevated brain natriuretic peptide levels or physical examination findings suggestive of heart failure, and those who meet the Framingham, MICE (Male, Infarction, Crepitations, Edema), or Netherlands criteria for heart failure. Patients with suspected heart failure should be referred for two-dimensional transthoracic echocardiography to confirm the diagnosis and identify preserved or reduced ejection fraction. Physicians should obtain a brain natriuretic peptide or N-terminal pro–brain natriuretic peptide level for patients with possible heart failure if the diagnosis is uncertain. The prognosis is comparable to that of heart failure with reduced ejection fraction and is worsened by higher levels of brain natriuretic peptide, older age, a history of myocardial infarction, and reduced diastolic function. Revascularization should be considered for patients with heart failure with preserved ejection fraction and coronary artery disease. Atrial fibrillation should be treated using a rate-control strategy and appropriate anticoagulation. Exercise and treatment by multidisciplinary teams may be helpful. If hypertension is present, it should be treated according to evidence-based guidelines. Patients with congestive symptoms should be treated with a diuretic. Multiple trials have not found medications to be an effective treatment, except for diuretics. Measurement of natriuretic peptides is useful in the evaluation of patients with suspected heart failure with preserved ejection fraction in the ambulatory setting. Echocardiographic findings of normal ejection fraction with impaired diastolic function confirm the diagnosis. Heart failure with preserved ejection fraction should be suspected in patients with typical symptoms (e.g., fatigue, weakness, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, edema) and signs (S3 heart sound, displaced apical pulse, and jugular venous distension) of chronic heart failure. ![]() It is more common among older patients and women, and results from abnormalities of active ventricular relaxation and passive ventricular compliance, leading to a decline in stroke volume and cardiac output. Heart failure with preserved ejection fraction, also referred to as diastolic heart failure, causes almost one-half of the 5 million cases of heart failure in the United States. ![]()
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