Heart failure with preserved ejection fraction

Also known as: diastolic heart failure · HFpEF

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United StatesACC/AHA

Current

2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure

AHA/ACC/HFSA · 2022

The current US heart failure guideline is organised by ejection fraction category, so heart failure with preserved ejection fraction (HFpEF) is treated as a defined subgroup with its own diagnostic and treatment recommendations rather than as a separate document. Clinicians seeking the official US position on HFpEF should look to the relevant EF-stratified sections of this single 2022 guideline. Metadata record only.

Jointly issued in 2022 by the American Heart Association, American College of Cardiology and Heart Failure Society of America. source
Replaces the 2013 ACCF/AHA heart failure guideline and its 2017 focused update. source
Expands attention to people at risk of, or showing early signs of, heart failure in addition to established disease. source

Verify against original ↗

EuropeESC

Current

2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure

European Society of Cardiology (ESC) · 2023 · 2023 Focused Update of the 2021 guideline

The current European heart-failure guidance — a 2023 focused update of the 2021 ESC guideline, revised after major new trials.

Gives a Class I recommendation for SGLT2 inhibitors in HFmrEF and HFpEF to reduce HF hospitalisation and cardiovascular death. source
Recommends intravenous iron for iron-deficient patients with HFrEF or HFmrEF to improve symptoms and quality of life. source

Verify against original ↗

US vs EU key differences

The two guidelines are broadly aligned on guideline-directed medical therapy, including the four foundational drug classes for HFrEF. source
The European guidance is more recent by way of its 2023 focused update, which strengthened SGLT2-inhibitor recommendations for HFmrEF/HFpEF. source

What changed recently

EU2021 → 2023 Focused Update of the 2021 guideline2023-08-25
Acting on EMPEROR-Preserved and DELIVER, the 2023 focused update gives dapagliflozin or empagliflozin a Class I recommendation in preserved and mildly reduced ejection fraction to cut heart failure hospitalisation and cardiovascular death, a treatment the 2021 guideline could not recommend.
source ↗curation confidence 90%
US2013 (with 2017 Focused Update) → 20222022-04-01
Replacing the 2013 guideline and 2017 focused update, the 2022 document redefines the heart failure stages around 'at risk' and 'pre-heart failure', formalises the mildly reduced ejection fraction category, and for the first time gives SGLT2 inhibitors a positive recommendation in preserved and mildly reduced ejection fraction.
source ↗curation confidence 90%

See the full update feed for changes across every system.