Heart failure with preserved ejection fraction (HFpEF) occurs when the heart muscle contracts normally (ejection fraction is 50% or above) but the left ventricle has become stiff and relaxes poorly, impairing its ability to fill properly between beats. This diastolic dysfunction reduces the amount of blood available to pump with each cycle, causing symptoms identical to other forms of heart failure despite a normal pumping percentage.
HFpEF accounts for approximately half of all heart failure cases and is more common in older women, and in people with hypertension, obesity, diabetes, or atrial fibrillation. Symptoms include breathlessness on exertion, fatigue, ankle swelling, and significantly reduced exercise tolerance.
Unlike heart failure with reduced ejection fraction (HFrEF), where several proven disease-modifying drug treatments exist, HFpEF has historically been harder to treat effectively. Management focuses on: controlling contributing conditions (blood pressure, atrial fibrillation, fluid retention), symptom relief with diuretics, and lifestyle measures including weight management. SGLT2 inhibitors (such as empagliflozin) have more recently demonstrated benefit in HFpEF in clinical trials and are increasingly prescribed.
Diagnosis requires [echocardiogram](/glossary/echocardiogram/) assessment of diastolic function alongside symptoms, [NT-proBNP](/glossary/nt-probnp/) levels, and clinical evaluation. [Cardiac rehabilitation](/glossary/cardiac-rehabilitation/) and supervised exercise can improve symptoms and quality of life even when medications offer limited benefit.
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