HFpEF Explained — Prevalence, New Advances, and How to Diagnose | NEJM

Why It Matters

Early identification and evidence‑based treatment of HFpEF can dramatically lower rehospitalization rates and healthcare costs, while improving outcomes for a rapidly expanding patient population.

Key Takeaways

• HFpEF prevalence rising, now surpasses HFrEF in older adults
• Obesity, diabetes, and aging drive HFpEF epidemic worldwide
• SGLT2 inhibitors, MRAs, and GLP-1 RAs improve outcomes
• H2FPEF score aids primary-care diagnosis but requires Doppler echo
• Consider amyloidosis, HCM, and other rare causes when standard workup fails

Summary

The video explains that heart failure with preserved ejection fraction (HFpEF) is becoming the dominant form of heart failure, especially among patients over 65, driven by an aging population and the global rise in obesity and diabetes. While historically under‑diagnosed, recent advances give clinicians concrete tools and therapies to manage this complex syndrome. Key data points include the fact that HFpEF now outnumbers HFrEF in prevalence, accounts for the majority of heart‑failure hospitalizations in seniors, and that about half of these patients are readmitted within six months. Effective pharmacologic options such as SGLT2 inhibitors, mineralocorticoid receptor antagonists, and GLP‑1 receptor agonists have demonstrated symptom relief and reduced hospitalizations. The presenter highlights practical diagnostic guidance, emphasizing a high index of suspicion, the use of the H2FPEF scoring system, and the necessity of Doppler echocardiography. He also warns clinicians to look for red‑flag signs of rarer etiologies—cardiac amyloidosis, hypertrophic cardiomyopathy, radiation‑induced disease—especially when standard treatment fails. Implications are clear: primary‑care physicians must become proficient in early HFpEF detection and initiate evidence‑based therapies promptly, while also recognizing when specialist referral is warranted. Early, targeted treatment can curb readmissions, improve quality of life, and reduce the growing healthcare burden of this increasingly common condition.

Original Description

This first episode of a three-part Double Take video miniseries on heart failure with preserved ejection fraction (HFpEF) from the New England Journal of Medicine discusses how HFpEF differs from heart failure with reduced ejection fraction, key risk factors, underlying causes, and the challenges of diagnosis. The cardiologists walk through the diagnostic evaluation, including use of the H2FPEF score to support clinical decision making.

For further reading, the following articles, referenced in this video, are available at NEJM.org: Empagliflozin in Heart Failure with a Preserved Ejection Fraction (Anker et al., in the October 14, 2021, issue, https://www.nejm.org/doi/full/10.1056/NEJMoa2107038 ), Semaglutide in Patients with Heart Failure with Preserved Ejection Fraction and Obesity (Kosiborod et al., in the September 21, 2023, issue, https://www.nejm.org/doi/full/10.1056/NEJMoa2306963 ), Finerenone in Heart Failure with Mildly Reduced or Preserved Ejection Fraction (Solomon et al., in the October 24, 2024, issue, https://www.nejm.org/doi/10.1056/NEJMoa2407107 ), Heart Failure with Preserved Ejection Fraction (Cannata and McDonagh, in the January 9, 2025, issue, https://www.nejm.org/doi/full/10.1056/NEJMcp2305181 ), and Tirzepatide for Heart Failure with Preserved Ejection Fraction and Obesity (Packer et al., in the January 30, 2025, issue, https://www.nejm.org/doi/full/10.1056/NEJMoa2410027 ).

Funding for this Double Take is provided by the Doris Duke Foundation, committed to building a creative, equitable, and sustainable future.

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