Unsolved Issues in Heart Failure with Preserved Ejection Fraction (HFpEF) Based on Cohort Studies and Clinical Trials

Heart failure with preserved ejection fraction (HFpEF) has now been well recognized. The proportion of patients with HFpEF is about 30-50% of the total HF population. In the registries, it is characterized by the predominance of elderly patients, women, and hypertension compared to heart failure with reduced ejection fraction (HFrEF) and its prognosis is nearly as poor as for that. Despite extensive efforts to investigate treatment options for this condition in randomized clinical trials such as CHARM-Preserved, PEP-CHF, I-PRESERVE, TOPCAT, and J-DHF, optimal medical management has not been established. Guidelines are therefore still restricted to modifying the risk factors predominant in HFpEF, such as to manage congestion with diuretics and obtain optimal treatment of hypertension and rate control of atrial fibrillation.
To further characterize the pathophysiology and establish optimal therapeutic strategies, we need to continue basic, clinical, and population studies targeting HFpEF. In this symposium, we are going to discuss unsolved issues in HFpEF based on cohort studies and clinical trials from Japan.