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World J Cardiol. Sep 26, 2015; 7(9): 544-554
Published online Sep 26, 2015. doi: 10.4330/wjc.v7.i9.544
Challenging aspects of treatment strategies in heart failure with preserved ejection fraction: “Why did recent clinical trials fail?”
Peter Moritz Becher, Nina Fluschnik, Stefan Blankenberg, Dirk Westermann
Peter Moritz Becher, Nina Fluschnik, Stefan Blankenberg, Dirk Westermann, Department of General and Interventional Cardiology, University Heart Center Eppendorf, 20246 Hamburg, Germany
Author contributions: All the authors equally contributed to this work.
Conflict-of-interest statement: The authors have no relationships with industry to report and have no conflict of interest including financial, personal, political interest in this study.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Peter Moritz Becher, MD, Department of General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Martinistraße 52, 20246 Hamburg, Germany. m.becher@uke.de
Telephone: +49-40-741054864 Fax: +49-40-741058862
Received: April 13, 2015
Peer-review started: April 18, 2015
First decision: May 13, 2015
Revised: May 29, 2015
Accepted: July 29, 2015
Article in press: August 3, 2015
Published online: September 26, 2015
Processing time: 160 Days and 21.2 Hours
Abstract

Heart failure (HF) is the leading cause of hospitalization among older adults and the prevalence is growing with the aging populations in the Western countries. Epidemiologic reports suggest that approximately 50% of patients who have signs or symptoms of HF have preserved left ventricular ejection fraction. This HF type predominantly affects women and the elderly with other co-morbidities, such as diabetes, hypertension, and overt volume status. Most of the current treatment strategies are based on morbidity benefits such as quality of life and reduction of clinical HF symptoms. Treatment of patients with HF with preserved ejection fraction displayed disappointing results from several large randomized controlled trials. The heterogeneity of HF with preserved ejection fraction, understood as complex syndrome, seems to be one of the primary reasons. Here, we present an overview of the current management strategies with available evidence and new therapeutic approach from drugs currently in clinical trials, which target diastolic dysfunction, chronotropic incompetence, and risk factor management. We provide an outline and interpretation of recent clinical trials that failed to improve outcome and survival in patients with HF with preserved ejection fraction.

Keywords: Diastolic dysfunction; Preserved ejection fraction; Co-morbidities; Clinical trials

Core tip: Heart failure (HF) has preserved left ventricular ejection fraction (HFpEF) accounts for approximately 50% of all patients diagnosed with HF, with similary poor outcomes. To date, only the prevention of HFpEF by treating the cardiovascular risk factors (coronary artery disease, atrial fibrillation, hypertension, diabetes, and obesity) has been shown to be efficient. This observation suggests that investigators in future trials should specify the indication of hospitalization for HF and may request to verify the details of patients’ admissions. We provide an outline and interpretation of recent clinical trials that failed to improve outcome and survival in patients with HF with preserved ejection fraction.