title: Optimizing the Management of Heart Failure With Preserved Ejection Fraction in the Elderly by Targeting Comorbidities (OPTIMIZE-HFPEF).
abstract: OBJECTIVE
  The pathophysiology of heart failure with preserved ejection fraction (HFPEF) is not fully understood. A recently proposed mechanism for HFPEF is that it is a systemic pro-inflammatory state induced by comorbidities, leading to microvascular endothelial dysfunction and subsequent cardiac remodeling and dysfunction. We hypothesize that targeting comorbidities will improve outcomes in elderly patients with HFPEF. Thus, the aim of this study is to determine whether the combination of systematic screening and optimal management of prespecified comorbidities associated with HFPEF improves outcomes.
  
  
  METHODS
  This multicenter, prospective, randomized intervention trial uses an open procedure with blinded endpoint assessment. Patients with HFPEF aged >60 years (n = 360) will be randomized 1:1 to the usual care or intervention arm of the trial. When randomized to the intervention arm, all patients will be systematically screened and optimally treated for the most frequent cardiovascular, metabolic, respiratory, and renal comorbidities. The primary endpoint is a composite clinical score that classifies each randomized patient as improved or deteriorated based on objective and subjective data at a 24-month follow-up performed by a blinded endpoint committee.
  
  
  CONCLUSIONS
  Rather than targeting cardiac dysfunction, our study aims to present evidence for a possible paradigm shift in the management of HFPEF. Our novel concept focuses on the management of comorbidities as predisposing factors in HFPEF.
authors.affiliation: Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden. Electronic address: Michael.fu@wlab.gu.se.
authors.forename: Michael
authors.initials: M
authors.lastname: Fu
authors.affiliation: Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Jingmin
authors.initials: J
authors.lastname: Zhou
authors.affiliation: Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
authors.forename: Erik
authors.initials: E
authors.lastname: Thunström
authors.affiliation: Department of Internal Medicine, Sahlgrenska University Hospital/Sahlgrenska, Gothenburg, Sweden.
authors.forename: Torbjörn
authors.initials: T
authors.lastname: Almgren
authors.affiliation: Center for Sleep and Vigilance Disorders, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Ludger
authors.initials: L
authors.lastname: Grote
authors.affiliation: Section for Heart Failure & Arrhythmia, Department of Cardiology, Sahlgrenska University Hospital /Sahlgrenska, Gothenburg, Sweden.
authors.forename: Entela
authors.initials: E
authors.lastname: Bollano
authors.affiliation: Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
authors.forename: Maria
authors.initials: M
authors.lastname: Schaufelberger
authors.affiliation: Department of Molecular and Clinical Medicine/Clinical Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden.
authors.forename: Magnus C
authors.initials: MC
authors.lastname: Johansson
authors.affiliation: Center for Biostatistics, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Max
authors.initials: M
authors.lastname: Petzold
authors.affiliation: Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; National Heart and Lung Institute, Imperial College, London, United Kingdom.
authors.forename: Karl
authors.initials: K
authors.lastname: Swedberg
authors.affiliation: Section for Heart Failure & Arrhythmia, Department of Cardiology, Sahlgrenska University Hospital /Sahlgrenska, Gothenburg, Sweden.
authors.forename: Bert
authors.initials: B
authors.lastname: Andersson
mesh_terms: D000368:Aged; D002908:Chronic Disease / Q000628:therapy*; D015897:Comorbidity; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D011446:Prospective Studies; D013318:Stroke Volume
keywords: HFPEF; Heart failure; comorbidity; management; mortality