Stephen J. Greene, MD, FACC, FHFSA

Navigating Access Barriers and Treatment Gaps in HFpEF Care

Access to care remains a major determinant of heart failure with preserved ejection fraction (HFpEF) outcomes. Panelists noted that disparities in insurance coverage, drug costs, and specialist availability limit the adoption of newer therapies such as finerenone.

They discussed how expanding formulary access, streamlining prior authorization processes, and improving clinician education can help close these gaps. Collaborative models between cardiology, primary care, and pharmacy teams were highlighted as effective tools for improving access.

Ultimately, addressing systemic barriers is essential for translating clinical advances into real-world benefit. The panel agreed that equity in care delivery must remain a central goal as HFpEF management continues to evolve.

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The discussion concludes with strategies to overcome access barriers and ensure equitable implementation of novel HFpEF therapies.

Challenges With Combining Nonsteroidal MRAs and Treatment Adherence in HFpEF

Panelists discussed that although nonsteroidal mineralocorticoid receptor antagonists such as finerenone offer clear clinical advantages, treatment adherence remains a critical barrier to success. Complex regimens, frequent laboratory monitoring, and adverse effect concerns often hinder consistent use.

They emphasized simplifying care through patient education, digital reminders, and coordinated follow-up. Addressing cost and access issues is equally important to ensuring long-term persistence with therapy.

Panelists concluded that optimizing adherence requires aligning clinical simplicity with patient empowerment. When patients understand their treatment rationale and receive ongoing support, therapy success rates improve significantly.

Panelists address adherence challenges and the need for careful coordination when integrating nonsteroidal MRAs into multifaceted treatment plans.

Strategies for Prevention of HFpEF

Panelists highlighted prevention as the most powerful but underutilized strategy in heart failure with preserved ejection fraction (HFpEF) care. Because the condition often develops from metabolic and hypertensive pathways, early lifestyle modification can delay or prevent disease onset.

They discussed how weight management, exercise, and strict blood pressure control significantly lower HFpEF risk. Early use of cardioprotective agents such as sodium-glucose transporter 2 inhibitors in high-risk populations may also offer preventive benefits.

Panelists concluded that prevention requires both system-level and patient-level commitment. Integrating cardiovascular risk screening into routine care and emphasizing patient education could reduce the growing burden of HFpEF worldwide.

Experts highlight preventive approaches, including risk factor control and early therapeutic intervention, to mitigate HFpEF development.

MRA Combination Therapies and Monitoring in HFpEF

Panelists discussed how combining mineralocorticoid receptor antagonists (MRAs) with other evidence-based therapies can provide synergistic benefits in heart failure with preserved ejection fraction (HFpEF) management. Nonsteroidal MRAs, in particular, pair well with sodium-glucose transporter 2 inhibitors and angiotensin receptor neprilysin inhibitors, helping reduce fibrosis, inflammation, and fluid overload.

The group emphasized that effective combination therapy depends on regular monitoring. Tracking potassium levels, renal function, and blood pressure is essential to prevent complications. They highlighted the need for clear follow-up plans and patient education to ensure adherence.

Ultimately, combining therapies in a strategic, individualized way can improve long-term outcomes. Panelists agreed that balancing efficacy with safety remains the foundation of successful HFpEF treatment.

Discussion centers on combining MRAs with other agents while maintaining vigilant monitoring to minimize risks and optimize long-term management.

Stephen J. Greene, MD, FACC, FHFSA

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