Diagnostic Approaches to Heart Failure With Preserved Ejection Fraction (HFpEF)　― Identification of Unrecognized HFpEF ―

Abstract

The development of life-saving pharmacotherapies such as the sodium-glucose cotransporter-2 inhibitors has changed heart failure with preserved ejection fraction (HFpEF) into a treatable disease. This paradigm shift in treatment has made the diagnosis of HFpEF more important. However, HFpEF is underdiagnosed in primary and secondary/tertiary care settings due to its diagnostic difficulties. Particularly, HFpEF is often missed in patients with obesity or atrial fibrillation. This review describes the reasons for the difficulty in diagnosing HFpEF and proposes a 5-step approach to identifying HFpEF in patients with unexplained dyspnea. Primary care physicians play a key role in the early identification of HFpEF in the community. We also discuss potential approaches to enhancing community referral and thus improving the rate of HFpEF diagnosis.