# The diagnosis and subclassification of heart failure with preserved ejection fraction: a review

## TL;DR

This review discusses the challenges in diagnosing and classifying heart failure with preserved ejection fraction and highlights the need for better understanding and categorization to improve treatment outcomes.

## Contribution

The paper provides a comprehensive analysis of diagnostic criteria and subcategorization schemes for HFpEF to address inconsistencies in clinical trials.

## Key findings

- HFpEF has a high mortality rate and is as prevalent as HFrEF.
- Diagnostic criteria for HFpEF are inconsistent, leading to variability in clinical trials.
- Subphenotype recognition is crucial for improving treatment success in HFpEF.

## Abstract

The incidence and prevalence of Heart Failure with Preserved Ejection Fraction (HFpEF) continues to rise and has a mortality rate comparable to that of Heart Failure with Reduced Ejection Fraction (HFrEF). Whilst there is general agreement on the diagnostic criteria for HFrEF, the diagnostic criteria for HFpEF vary significantly which has resulted in inconsistent and varying inclusion criteria in clinical trials for this challenging syndrome. The HFpEF population is diverse and heterogeneous and various schemes of subcategorisation have been proposed. Failure of treatment trials to date can be explained, in part, by failure to consider the underlying sub-phenotypes within the HFpEF population. This review discusses the diagnostic uncertainty surrounding HFpEF and details the historical progression in the understanding of diastolic dysfunction and its role in the heart failure syndrome. An analysis of diagnostic criteria and suggested phenotypic subcategorisation is accompanied by a discussion of echocardiographic and invasive haemodynamic criteria. A detailed summary of the varied inclusion criteria and definitions employed in recent clinical trials is provided.