title: Update on diastolic heart failure or heart failure with preserved ejection fraction in the older adults.
abstract: Nearly half of all heart failure (HF) patients have diastolic HF (DHF) or clinical HF with normal or near-normal left ventricular ejection fraction (LVEF). Although the terminology has not been clearly defined, it is increasingly being referred to as HF with preserved ejection fraction (HFPEF). The prevalence of HFPEF increases with age, especially among older women. Identifying HFPEF is important because the etiology, pathogenesis, prognosis, and optimal management may differ from that for systolic HF (SHF) or HF with reduced ejection fraction. The clinical presentation of HF is similar for both SHF and HFPEF. As in SHF, HFPEF is a clinical diagnosis. Once a clinical diagnosis of HF has been made, the presence of HFPEF can be established by confirming a normal or near-normal LVEF, often by an echocardiogram. HFPEF is often associated with a history of hypertension, concentric left ventricular hypertrophy, vascular stiffness, and left ventricular diastolic dysfunction. As in SHF, HFPEF is also associated with poor outcomes. While therapies with angiotensin-converting enzyme inhibitors and beta-blockers improve outcomes in SHF, there is currently no such evidence of their benefits in older HFPEF patients. In this review recent advances in the diagnosis and management of HFPEF in older adults are discussed.
authors.affiliation: Division of Geriatric Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada T6G 2G3. KAlagiakri@aol.com
authors.forename: Kannayiram
authors.initials: K
authors.lastname: Alagiakrishnan
authors.forename: Maciej
authors.initials: M
authors.lastname: Banach
authors.forename: Linda G
authors.initials: LG
authors.lastname: Jones
authors.forename: Subrata
authors.initials: S
authors.lastname: Datta
authors.forename: Ali
authors.initials: A
authors.lastname: Ahmed
authors.forename: Wilbert S
authors.initials: WS
authors.lastname: Aronow
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D054316:Biomarkers, Pharmacological / Q000097:blood; D058406:Cardiac Resynchronization Therapy; D004232:Diuretics / Q000627:therapeutic use; D004452:Echocardiography; D004562:Electrocardiography; D015316:Genetic Therapy; D054144:Heart Failure, Diastolic / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D013318:Stroke Volume; D016277:Ventricular Function, Left
chemical_list: D000959:Antihypertensive Agents; D054316:Biomarkers, Pharmacological; D004232:Diuretics