Exploring the ‘New Era’ of HFpEF Treatment: More Options Exist, but Challenges Remain. January 14, 2025
Exploring the ‘New Era’ of HFpEF Treatment: More Options Exist, but Challenges Remain. January 14, 2025.
In recent years, the treatment landscape for heart failure with preserved ejection fraction (HFpEF) has evolved significantly, introducing several new therapies. At the 2024 American Heart Association (AHA) meeting, Clyde Yancy, MD, MSc, professor and chief of cardiology with Northwestern Medicine and a former AHA president discussed the advancements in HFpEF treatment with Cardiovascular Business, emphasizing the growing excitement in cardiology over these developments.
HFpEF, which involves normal ejection fraction but impaired heart relaxation, has traditionally been difficult to manage, with treatment options previously limited to symptom control through diuretics. Yancy highlighted the shift in understanding and treating HFpEF, now supported by substantial clinical evidence demonstrating the efficacy of new targeted therapies.
Promising New Therapies for HFpEF
Yancy described a “new era” in HFpEF treatment, with four major therapies emerging:
1. SGLT2 Inhibitors: Originally for diabetes, these inhibitors have shown significant benefits in heart failure patients, including those with HFpEF.
2. Mineralocorticoid Receptor Antagonists (MRAs): Finerenone, a nonsteroidal MRA, has proven effective in reducing symptoms and hospitalizations for HFpEF patients.
3. Incretin Therapies: Dual incretin agonists and GLP-1 receptor agonists like semaglutide offer promising results in symptom relief and hospitalization reduction.
4. Combination Approaches: Integrating these therapies allows clinicians to employ a comprehensive treatment algorithm for HFpEF, marking a significant improvement from the past.
Challenges and Future Opportunities
Despite these advancements, Yancy noted that gaps remain, particularly in finding therapies that reduce cardiovascular mortality in HFpEF patients. He emphasized the need for continued research, especially in areas like inflammation-targeting drugs and potential implantable device therapies.
