title: Heart failure with preserved ejection fraction in the elderly: scope of the problem.
abstract: Heart failure with preserved ejection fraction (HFpEF) is the most common form of heart failure (HF) in older adults, particularly women, and is increasing in prevalence as the population ages. With morbidity and mortality on par with HF with reduced ejection fraction, it remains a most challenging clinical syndrome for the practicing clinician and basic research scientist. Originally considered to be predominantly caused by diastolic dysfunction, more recent insights indicate that HFpEF in older persons is typified by a broad range of cardiac and non-cardiac abnormalities and reduced reserve capacity in multiple organ systems. The globally reduced reserve capacity is driven by: 1) inherent age-related changes; 2) multiple, concomitant co-morbidities; 3) HFpEF itself, which is likely a systemic disorder. These insights help explain why: 1) co-morbidities are among the strongest predictors of outcomes; 2) approximately 50% of clinical events in HFpEF patients are non-cardiovascular; 3) clinical drug trials in HFpEF have been negative on their primary outcomes. Embracing HFpEF as a true geriatric syndrome, with complex, multi-factorial pathophysiology and clinical heterogeneity could provide new mechanistic insights and opportunities for progress in management. This article is part of a Special Issue entitled CV Aging.
authors.affiliation: Cardiology Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Bharathi
authors.initials: B
authors.lastname: Upadhya
authors.affiliation: Geriatrics and Cardiovascular Sciences, Baylor College of Medicine, Houston Methodist Hospital, Houston, TX, USA.
authors.forename: George E
authors.initials: GE
authors.lastname: Taffet
authors.affiliation: Cardiology Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Che Ping
authors.initials: CP
authors.lastname: Cheng
authors.affiliation: Cardiology Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA. Electronic address: dkitzman@wakehealth.edu.
authors.forename: Dalane W
authors.initials: DW
authors.lastname: Kitzman
mesh_terms: D000368:Aged; D000375:Aging / Q000378:metabolism / Q000473:pathology*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000818:Animals; D004656:Enalapril / Q000627:therapeutic use; D005081:Exercise Therapy; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology* / Q000628:therapy*; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000187:drug effects / Q000378:metabolism / Q000473:pathology; D011994:Recombinant Proteins / Q000627:therapeutic use; D012065:Relaxin / Q000627:therapeutic use; D012307:Risk Factors; D013318:Stroke Volume / Q000187:drug effects; D059289:Vascular Stiffness / Q000187:drug effects
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D011994:Recombinant Proteins; C577649:serelaxin protein, human; D004656:Enalapril; D012065:Relaxin
keywords: Aging; Heart failure with preserved ejection fraction; Review; Systemic disorder