Emerging Strategies in the Management of Heart Failure with Preserved Ejection Fraction: Integrating SGLT2 Inhibitors, Lifestyle Interventions, and Multidisciplinary Care
DOI:
https://doi.org/10.56532/mjsat.v5i4.587Keywords:
HFpEF, Lifestyle interventions, Multidisciplinary care, SGLT2 inhibitors, Symptom managementAbstract
Heart failure with preserved ejection fraction (HFpEF) is a complex clinical syndrome characterized by heart failure symptoms despite a left ventricular ejection fraction ≥50%, representing about 50% of all heart failure cases. Its increasing prevalence, driven by an aging population and comorbidities like hypertension, diabetes, and obesity, poses significant challenges due to frequent hospitalizations, impaired quality of life, and high mortality rates. The pathophysiology of HFpEF is multifactorial, involving systemic inflammation, endothelial dysfunction, myocardial fibrosis, and increased ventricular stiffness, indicating a systemic syndrome requiring a multidisciplinary treatment approach. While current guidelines emphasize symptom relief, comorbidity management, and lifestyle changes, the emergence of sodium-glucose cotransporter 2 (SGLT2) inhibitors has revolutionized HFpEF management. Large randomized controlled trials like EMPEROR-Preserved and DELIVER have demonstrated their ability to significantly reduce heart failure hospitalizations and improve quality of life. Additionally, structured exercise training, dietary modifications, and behavioral support have shown benefits in enhancing functional capacity and overall well-being. Multidisciplinary care models involving collaboration among various healthcare professionals have the potential to optimize patient-centered care and improve outcomes. However, challenges persist, including the heterogeneity of HFpEF phenotypes, underrepresentation of high-risk populations in trials, and inconsistent implementation of lifestyle and multidisciplinary interventions. Future directions should focus on personalized treatment strategies guided by deep phenotyping and biomarkers, equitable access to care, and the integration of pharmacological therapies with scalable lifestyle interventions and technology-enabled monitoring systems. Addressing these issues will be crucial in alleviating the global burden of HFpEF and improving patient outcomes.
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