Heart Failure with Preserved Ejection Fraction

• Published in: The New England journal of medicine Vol. 375; no. 19; pp. 1868 - 1877
• Main Author: Redfield, Margaret M
• Format: Journal Article
• Language: English
• Published: United States Massachusetts Medical Society 10.11.2016
• Subjects: Aged; Algorithms; Cardiac arrhythmia; Catheterization; Diuretics; Diuretics - therapeutic use; Dyspnea; Echocardiography; Edema; Ejection fraction; EKG; Exercise; Exercise Tolerance; Female; Heart diseases; Heart failure; Heart Failure - diagnosis; Heart Failure - physiopathology; Heart Failure - therapy; Humans; Hypertension; Immunological tolerance; Patients; Peptides; Radiography; Stroke Volume; Structure-function relationships
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMcp1511175

Management of heart failure with preserved ejection fraction includes diuretics, treatment of coexisting conditions, aerobic exercise, self-care, and disease management programs, but medications that are effective for reduced ejection fraction have not been beneficial. Foreword This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author’s clinical recommendations. Stage A 73-year-old woman with a history of dyspnea on exertion presents for a follow-up visit after hospitalization for acute worsening of dyspnea and orthopnea. On admission to the hospital, the patient had atrial fibrillation with a ventricular rate of 120 beats per minute, and chest radiography revealed pulmonary venous hypertension. Despite anticoagulation, rate control with a beta-blocker, and administration of loop diuretics during the hospitalization, she continues to have fatigue and exertional dyspnea. On physical examination, the body-mass index (BMI; the weight in kilograms divided by the square of the height in meters) is 39, pulse 76 beats per . . .