HFpEF Management (ESC 2023)
HFpEF Management (ESC 2023): HFpEF Diagnosed → SGLT2 Inhibitor (Class I) → KEY: HFpEF ≠ HFrEF → Comorbidity Management → If AFib Present.
Interactive Decision Tree
Algorithm Steps
- ▶Start
HFpEF Diagnosed
LVEF ≥50% + elevated filling pressures
- HFA-PEFF score ≥5
- or Invasive confirmation
- ●Action
SGLT2 Inhibitor (Class I)
ONLY Class I drug therapy for HFpEF
- Dapagliflozin 10mg OR Empagliflozin 10mg
- Regardless of diabetes status
- EMPEROR-Preserved, DELIVER trials
- Reduces HF hospitalization + CV death
- ⚠Warning
KEY: HFpEF ≠ HFrEF
Different evidence base
- No quadruple therapy
- MRA, ARNI: limited evidence
- Focus on comorbidities
- ●Action
Comorbidity Management
PRIMARY treatment strategy
- Hypertension - tight control
- Atrial fibrillation - rate/rhythm
- Coronary artery disease
- Obesity - weight management
- Diabetes - optimal glycemic control
- Iron deficiency - IV iron
- ●Action
If AFib Present
Rhythm control may help
- Rate or rhythm control
- Anticoagulation
- Consider ablation for symptoms
- ●Action
Exercise Training
Class I recommendation
- Supervised cardiac rehab
- Improves functional capacity
- Improves quality of life
- ✓Outcome
Follow-Up
Regular reassessment, optimize comorbidities
- ●Action
Other Therapies (Limited Evidence)
Consider on individual basis
- MRA: Some benefit (Class IIb)
- ARB/ARNI: Inconsistent data
- Beta-blockers: For rate control only
- ●Action
Diuretics for Congestion
Symptom relief
- Loop diuretics for volume overload
- Dose to euvolemia
- Monitor for over-diuresis
Guideline Source
2023 ESC Focused Update on Heart Failure
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- HFA-PEFF diagnostic criteria not detailed
- SGLT2i is ONLY Class I therapy (different from HFrEF)
- Comorbidity management is primary focus
Contraindicated Populations
Applicable Regions
EU: ESC 2023 - SGLT2i Class I for HFpEF
US: ACC/AHA similar recommendations
Next steps
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Related Resources
Frequently Asked Questions
What is the HFpEF Management (ESC 2023)?
The HFpEF Management (ESC 2023) is a management clinical algorithm for Cardiology. It provides a structured decision tree to guide clinical decision-making, based on 2023 ESC Focused Update on Heart Failure.
What guideline is the HFpEF Management (ESC 2023) based on?
This algorithm is based on 2023 ESC Focused Update on Heart Failure (DOI: 10.1093/eurheartj/ehad195).
What are the limitations of the HFpEF Management (ESC 2023)?
Known limitations include: HFA-PEFF diagnostic criteria not detailed; SGLT2i is ONLY Class I therapy (different from HFrEF); Comorbidity management is primary focus. Individual patient factors may require deviation from these recommendations.
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