Heart failure with preserved ejection fraction (HFpEF)

It is astonishing that in recent years heart failure with preserved ejection fraction (HFpEF) has emerged as the most common form of heart failure, when it was barely mentioned 20 years ago. HFpEF was evident 20 years ago, but it was referred to as "diastolic heart failure" and was somewhat understudied and was clinically not very well characterized. HFpEF's prevalence now is at least equivalent to heart failure with reduced ejection fraction (HFrEF) and probably somewhat greater. This epidemic of HFpEF continues to grow. Of the six million Americans suffering with heart failure, about half have HFpEF and the other half have HFrEF. Substantial overlap exists, with some patients having a combination of HFrEF and HFpEF and nearly all patients with HFrEF having some element of diastolic dysfunction. The prevalence of HFpEF is rapidly increasing commensurate with the increase in people living to an advanced age. Undoubtedly, many patients, to some extent, manifest both phenotypes-HFpEF and HFrEF. This chapter primarily focuses on patients with HFpEF.