{"id":7061,"date":"2025-05-22T13:37:17","date_gmt":"2025-05-22T10:37:17","guid":{"rendered":"https:\/\/jordan-cardiac.org\/?p=7061"},"modified":"2025-05-22T13:37:17","modified_gmt":"2025-05-22T10:37:17","slug":"summary-of-clinical-guidelines-diagnosis-and-management-of-heart-failure-with-preserved-ejection-fraction-in-primary-care-diagnosing-and-managing-hfpef-heart-failure-with-preserved-ejection","status":"publish","type":"post","link":"https:\/\/jordan-cardiac.org\/en\/summary-of-clinical-guidelines-diagnosis-and-management-of-heart-failure-with-preserved-ejection-fraction-in-primary-care-diagnosing-and-managing-hfpef-heart-failure-with-preserved-ejection\/","title":{"rendered":"SUMMARY of clinical guidelines:\u00a0 Diagnosis and Management of Heart Failure with Preserved Ejection Fraction in Primary Care : Diagnosing and Managing HFpEF (Heart Failure with Preserved Ejection Fraction)"},"content":{"rendered":"
SUMMARY of clinical guidelines:<\/div>\n
Diagnosis and Management of Heart Failure with Preserved Ejection Fraction in Primary Care : Diagnosing and Managing HFpEF (Heart Failure with Preserved Ejection Fraction)<\/div>\n
<\/div>\n
Source: Primary Care Hacks (Medscape UK)<\/div>\n
Published: May 2, 2025<\/div>\n
Authors: Dr. Patricia Campbell, Dr. Eimear Darcy, Dr. Kevin Fernando<\/div>\n
<\/div>\n
1. What is HFpEF?<\/div>\n
\u2022 A type of heart failure where the heart pumps normally (preserved ejection fraction), but doesn\u2019t fill properly.<\/span><\/div>\n
\u2022 Common in older adults and twice as common in women.<\/span><\/div>\n
\u2022 Often linked to conditions like diabetes, obesity, hypertension, CKD, AF, and inflammation.<\/span><\/div>\n
<\/div>\n
2. When to Suspect HFpEF in Primary Care:<\/div>\n
\u2022 Patients with ankle swelling using diuretics without a clear heart failure diagnosis.<\/span><\/div>\n
\u2022 Symptoms: shortness of breath, reduced exercise tolerance, fatigue, swelling.<\/span><\/div>\n
\u2022 Signs may include: raised JVP, lung crackles, peripheral edema, heart murmurs, ascites.<\/span><\/div>\n
\u2022 Atypical symptoms include: dizziness, palpitations, bloating, confusion.<\/span><\/div>\n
<\/div>\n
3. Testing and Referral Steps:<\/div>\n
\u2022 Check NT-proBNP levels.<\/span><\/div>\n
\u2022 Perform ECG, chest X-ray, blood tests (including iron, kidney, thyroid).<\/span><\/div>\n
\u2022 Rule out other conditions like COPD, asthma, obesity, anaemia.<\/span><\/div>\n
\u2022 Use frailty scale for patients >65.<\/span><\/div>\n
\u2022 Refer to cardiology or HF service if HFpEF is suspected\u2014even if NT-proBNP is normal (especially in obese patients).<\/span><\/div>\n
<\/div>\n
4. Initial Management While Awaiting Referral:<\/div>\n
\u2022 Use loop diuretics (e.g., furosemide) for fluid overload.<\/span><\/div>\n
\u2022 Start an SGLT2 inhibitor (dapagliflozin or empagliflozin 10mg daily).<\/span><\/div>\n
<\/div>\n
5. Main Therapies Recommended:<\/div>\n
\u2022 SGLT2 inhibitors are the only class with proven benefit in HFpEF.<\/span><\/div>\n
\u2022 Diuretics for symptom control, not mortality benefit.<\/span><\/div>\n
\u2022 Avoid beta-blockers unless needed for AF or angina.<\/span><\/div>\n
\u2022 Future treatments under study: finerenone, semaglutide, tirzepatide (especially in obese patients).<\/span><\/div>\n
<\/div>\n
6. Other Important Interventions:<\/div>\n
\u2022 Treat related conditions: diabetes, CKD, high blood pressure, obesity, anaemia, AF.<\/span><\/div>\n
\u2022 Encourage physical activity and refer to cardiac rehab.<\/span><\/div>\n
\u2022 Check for sleep apnea, depression, frailty.<\/span><\/div>\n
\u2022 Promote salt reduction, smoking cessation, alcohol moderation.<\/span><\/div>\n
\u2022 Stay updated on vaccinations.<\/span><\/div>\n
\u2022 Consider individualized care plans for patients with severe frailty or approaching end of life.<\/span><\/div>\n
<\/div>\n
7. Prescribing Notes & Warnings:<\/div>\n
\u2022 Avoid NSAIDs, pioglitazone, and some DPP4 inhibitors (like saxagliptin).<\/span><\/div>\n
\u2022 Monitor for potassium issues; use MRAs where appropriate.<\/span><\/div>\n
See below for more information in this regard.<\/div>\n
\u2022 Adjust insulin\/sulfonylurea doses when starting SGLT2 inhibitors.<\/span><\/div>\n
\u2022 Discuss contraception and pregnancy risks in women of childbearing age.<\/span><\/div>\n
\u00a0 Note:<\/div>\n
\u00a0 \u00a0 .\u00a0 \u00a0 \u00a0MRAs (Mineralocorticoid Receptor Antagonists) like spironolactone or eplerenone can be helpful in certain heart failure patients, but in HFpEF, their use is more selective. Here\u2019s when they may be appropriate:<\/div>\n
<\/div>\n
When is an MRA appropriate in HFpEF?<\/div>\n
1. If the patient has signs of fluid overload + low potassium (K+):<\/span><\/div>\n
\u2022 Instead of giving potassium supplements alone, you can consider starting or increasing an MRA, as MRAs help retain potassium and reduce fluid retention.<\/span><\/div>\n
2. If there\u2019s coexisting hypertension that\u2019s not well controlled.<\/span><\/div>\n
\u2022 MRAs may help lower blood pressure and improve symptoms.<\/span><\/div>\n
3. If the patient has been hospitalized with HFpEF and is at higher risk of recurrence or has elevated BNP\/NT-proBNP, an MRA may be added\u2014especially if SGLT2i and diuretics are already in use.<\/span><\/div>\n
4. If there are signs of aldosterone excess (e.g. resistant hypertension):<\/span><\/div>\n
\u2022 MRAs block aldosterone and help reduce cardiac fibrosis and vascular stiffness.<\/span><\/div>\n
5. If tolerated in terms of kidney function and potassium level:<\/span><\/div>\n
\u2022 eGFR should be \u226530 mL\/min\/1.73 m\u00b2<\/span><\/div>\n
\u2022 Serum potassium should be \u22645.0 mmol\/L before starting<\/span><\/div>\n
\u2022 Regular monitoring is essential after starting<\/span><\/div>\n
<\/div>\n
When NOT to use MRAs:<\/div>\n
\u2022 Severe kidney disease (eGFR <30)<\/span><\/div>\n
\u2022 High potassium (>5.0)<\/span><\/div>\n
\u2022 History of hyperkalemia with MRA use<\/span><\/div>\n
\u2022 Poor monitoring access (risk .<\/span><\/div>\n
of undetected hyperkalemia)<\/div>\n
<\/div>\n
https:\/\/click.mail.medscape.com\/?qs=2554d9ca9f8d7b429985ddaec082cdef017118acda3ed2b2073842abfd6687d601d4fca275e2bddfaa3921558f5dfba5c80a67e93ed01015337e8423be51fc57<\/a><\/div>\n","protected":false},"excerpt":{"rendered":"

SUMMARY of clinical guidelines: Diagnosis and Management of Heart Failure with Preserved Ejection Fraction in Primary Care : Diagnosing and Managing HFpEF (Heart Failure with Preserved Ejection Fraction) Source: Primary Care Hacks (Medscape UK) Published: May 2, 2025 Authors: Dr. Patricia Campbell, Dr. Eimear Darcy, Dr. Kevin Fernando 1. What is HFpEF? \u2022 A type […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-7061","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/7061","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/comments?post=7061"}],"version-history":[{"count":1,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/7061\/revisions"}],"predecessor-version":[{"id":7062,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/7061\/revisions\/7062"}],"wp:attachment":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/media?parent=7061"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/categories?post=7061"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/tags?post=7061"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}