Sequencing Therapies in HFpEF Care

Panelists emphasized that optimal sequencing of therapies is essential to achieving meaningful outcomes in heart failure with preserved ejection fraction management. With several drug classes now demonstrating benefit—including mineralocorticoid receptor antagonists (MRAs), sodium-glucose transporter 2 (SGLT2) inhibitors, and angiotensin receptor neprilysin inhibitors (ARNis)—clinicians must decide how best to introduce and layer these treatments.

They discussed the importance of tailoring sequencing to patient phenotype, comorbidities, and tolerability. For instance, SGLT2 inhibitors may be initiated early due to their renal and metabolic benefits whereas MRAs and ARNis can be added as tolerated to further reduce risk. Proper sequencing helps improve adherence and minimizes adverse effects.

Panelists agreed that ongoing clinical evaluation and patient engagement are vital for maintaining therapeutic success. Developing structured protocols and team-based follow-up ensures that treatment escalation happens safely and effectively over time.