Does My Patient With Multiple Comorbidities Have Heart Failure With Preserved Ejection Fraction, and Does It Matter?

Dmitry Abramov, MD


J Am Board Fam Med. 2019;32(3):424-427. 

In This Article

Abstract and Introduction


Heart Failure with Preserved Ejection Fraction (HFpEF) is a common diagnosis and accounts for half or more of all cases of heart failure. Despite its high prevalence and significant morbidity, the pathophysiology of HFpEF remains incompletely understood. Patients diagnosed with HFpEF often have significant cardiac and extra-cardiac comorbidities. Given the availability of evidence-based treatments for common comorbidities, but not for HFpEF, the necessity of diagnosing HFpEF among symptomatic elderly patients with multiple comorbidities is unclear. This commentary raises the question of whether the search for the diagnosis of HFpEF should instead be refocused to the management of common comorbidities without necessitating the heart failure diagnosis.


Heart failure with preserved ejection fraction (HFpEF) comprises about half of the cases of heart failure in the United States.[1] Despite its growing prevalence and significant morbidity, HFpEF remains incompletely understood and diagnosis in the community setting may be difficult. Widely used diagnostic criteria that incorporate clinical findings with laboratory values and echocardiographic parameters lack sensitivity which may result in underdiagnosis.[2] Overdiagnosis based on vague symptoms and nonspecific diagnostic parameters may likewise be problematic. The concern of over- and underdiagnosis is further compounded by the lack of evidence-based treatments for those diagnosed with HFpEF. Patients with HFpEF tend to be older, with multiple cardiac and noncardiac comordbitities.[3] This begs the question of whether diagnosis of HFpEF remains critical to optimize the care of predominantly older patients with multiple comorbidities.