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@article{Recent Advances in the Management of Heart Failure with Preserved Ejection Fraction: A Comprehensive Review_2026, volume={4}, url={https://www.globapc.com/index.php/gjmps/article/view/79}, abstractNote={
Background: Heart failure with preserved ejection fraction (HFpEF) accounts for more than half of all prevalent heart failure and carries morbidity and mortality comparable to heart failure with reduced ejection fraction. For nearly two decades no therapy convincingly altered its natural history, and management was confined to diuresis and treatment of comorbidities. Objective: To critically synthesise contemporary evidence on the pathophysiology, diagnosis and, in particular, the rapidly evolving pharmacological, nonpharmacological and device-based management of HFpEF, and to compare current international guideline and consensus positions. Methods: A structured narrative review was conducted. PubMed/MEDLINE, Scopus, Web of Science, Embase and the Cochrane Library were searched from 1 January 2019 to 30 Jun 2026 using MeSH terms and free-text combinations relating to heart failure, preserved ejection fraction, diastolic dysfunction and therapy. Randomised controlled trials, meta-analyses, large registries, guideline documents and mechanistic studies published in peer-reviewed indexed journals were eligible. Reference lists of retrieved articles and late-breaking trial presentations from major cardiology congresses were hand-searched. Results: Four therapeutic classes now have randomised evidence of benefit. Sodium-glucose cotransporter-2 inhibitors reduce cardiovascular death or worsening heart failure by approximately 20 percent across the ejection fraction spectrum. The non-steroidal mineralocorticoid receptor antagonist finerenone reduced total worsening heart failure events and cardiovascular death in FINEARTS-HF, whereas steroidal agents remain unproven in the recently reported SPIRITHF trial. Incretin-based therapies, semaglutide and tirzepatide, produce large improvements in symptoms and exercise capacity and, in SUMMIT, reduced heart failure events in obesityrelated HFpEF. Sacubitril-valsartan retains a selective role at the lower end of the ejection fraction range and in women. Device-based left atrial decompression has not shown consistent benefit, while activin signalling inhibition and interleukin-6 blockade are under active investigation. Conclusion: HFpEF has moved from therapeutic nihilism to a phenotype-directed, multidrug treatment paradigm. Timely diagnosis using validated scores, systematic exclusion of mimics and early initiation of disease-modifying therapy are now the principal determinants of outcome.
}, number={4}, journal={Global journal of medical and pharmaceutical sciences}, year={2026}, month={Aug.}, pages={26–40} }