Expert Insights on Challenging HFpEF Cases: From Diagnosis to Guideline-Based Management

In this episode of CardioNerds Rounds, Dr. Loie Farina and heart failure specialist Dr. Jane Wilcox review two complex cases of heart failure with preserved ejection fraction (HFpEF). The first case involves an octogenarian with HFpEF, atrial fibrillation, and chronic kidney disease whose right heart catheterization with exercise reveals exertional congestion. The discussion emphasizes the importance of diuretics, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 (SGLT2) inhibitors. In the second case, which involves a woman in her 70s with dyspnea, hypertension, obesity, and mild echocardiographic findings, Dr. Wilcox outlines using tools such as the H₂FPEF score to assess HFpEF probability and highlights the significance of evaluating for reversible contributors such as coronary artery disease in line with American College of Cardiology/American Heart Association/Heart Failure Society of American (ACC/AHA/HFSA) guideline recommendations.