# Heart Failure with Preserved Ejection Fraction in Egypt: An Expert Opinion

## TL;DR

This paper reviews the challenges and treatment of heart failure with preserved ejection fraction in Egypt, focusing on diagnosis, management, and future research directions.

## Contribution

The paper provides expert recommendations for HFpEF management in Egypt, emphasizing the use of the H2FPEF scoring system and SGLT2 inhibitors.

## Key findings

- HFpEF diagnosis in Egypt commonly uses the H2FPEF scoring system due to the absence of a golden standard.
- SGLT2 inhibitors are recommended as the mainstay treatment for HFpEF patients in Egypt.
- Multidrug regimens tailored to symptoms and comorbidities are essential for effective HFpEF management.

## Abstract

Heart failure with preserved ejection fraction (HFpEF) is an ongoing challenge for healthcare systems. Major limitations that hinder adequate control of the disease, including an incomplete understanding of its pathophysiology, limited therapy options, and the absence of sufficient information on the management of comorbidities. Diagnosis and management of HFpEF in Egypt lack standardization as they are complicated with multiple comorbidities and limited by the lack of resources and data on epidemiology and patient characteristics. Diagnostic procedures for HFpEF should be implemented through guideline-specified scoring systems, due to the heterogeneity of clinical presentations and the absence of a golden standard for confirming HFpEF. In Egypt, the H2FPEF scoring system is more commonly used for establishing HFpEF diagnosis. All HFpEF patients should be treated through multidrug regimens tailored for their state, symptoms, and comorbidities, with sodium-glucose cotransporter-2 (SGLT2) inhibitors as the mainstay of treatment together with either one or a combination of loop diuretic and aldosterone antagonists. This paper provides an integrated review of epidemiology, means of diagnosis, current and novel pharmacological therapy options for HFpEF patients in the light of the recent advances in treatment of HFpEF, discussing means of healthcare delivery and unmet needs, and proposing recommendations for clinical practice and pathways for future research.