Evolution of a Geriatric Syndrome: Pathophysiology and Treatment of Heart Failure With Preserved Ejection Fraction

Bharathi Upadhya, MD; Barbara Pisani, MD; Dalane W. Kitzman, MD


J Am Geriatr Soc. 2017;65(11):2431-2440. 

In This Article

Conclusions and Future Directions

HFpEF is the most common form of HF, is nearly unique to older adults and is a true geriatric syndrome. Nonpharmacological therapies, including disease management, ET, and caloric restriction weight loss in obese individuals, have been shown to be effective, but pharmacological trials have generally been neutral on their primary outcomes, including clinical endpoints and exercise function. An evolving paradigm suggests that, like other geriatric syndromes, HFpEF is complex and multifactorial, probably systemic, and clinically heterogeneous and has a multifactorial pathophysiology, underlying age-related changes, frequent multiple chronic comorbidities, and multiorgan involvement. If this is so, novel approaches to treatment that have systemic effects and influence inflammation and multiple organ systems may be fruitful.[97] In addition, future studies should account for emerging data indicating the presence of multiple, potentially distinct HFpEF phenotypes.[97] Continued progress is imperative, because HFpEF is the most common cardiovascular disorder for which there are no therapies definitively shown to alter prognosis.