Epidemiology and Classification of Heart Failure Based on Ejection Fraction

Heart failure with preserved ejection fraction (HFpEF) remains a challenging and increasingly prevalent condition, often driven by aging populations and overlapping comorbidities such as diabetes, hypertension, and obesity. Panelists discussed that the heterogeneity of HFpEF contributes to diagnostic uncertainty and variable treatment responses, underscoring the need for a tailored approach. They noted that recognizing HFpEF as a syndrome rather than a single disease entity helps clinicians address its diverse pathophysiologic mechanisms, including myocardial stiffness, vascular dysfunction, and inflammation.

The discussion emphasized how advances in clinical evidence are reshaping management strategies. Nonsteroidal mineralocorticoid receptor antagonists (MRAs) such as finerenone, along with sodium-glucose transporter 2 inhibitors and angiotensin receptor neprilysin inhibitors, were highlighted as central components of evolving guideline-directed therapy. Panelists agreed that combining these agents, when appropriate, can improve patient outcomes and reduce hospitalizations. However, they also acknowledged that real-world implementation depends on careful monitoring and individualized therapy selection, particularly for patients with chronic kidney disease or diabetes.

Panelists concluded that improving HFpEF outcomes requires more than pharmacologic innovation; it demands systemwide collaboration and patient engagement. Greater clinician education, early detection initiatives, and integrated care pathways can help bridge gaps between evidence and practice. By aligning multidisciplinary care with precision diagnostics and proactive management, the field can move toward more consistent, equitable outcomes for this complex patient population.