REVIEW   

Minerva Medica 2025 Mar 27

DOI: 10.23736/S0026-4806.25.09656-9

Copyright © 2025 EDIZIONI MINERVA MEDICA

language: English

Advancing heart failure management: a comprehensive review of current and emerging therapies for heart failure with preserved ejection failure

Siddharth P. AGRAWAL ¹, Ritu C. TATED ², Darshilkumar MAHETA ², Wilbert S. ARONOW ³ ✉

¹ Department of Internal Medicine, New York Medical College, Landmark Medical Center, Woonsocket, RI, USA; ² Department of Public Health, New York Medical College, Valhalla, NY, USA; ³ Department of Cardiology and Medicine, New York Medical College and Westchester Medical Center, Valhalla, NY, USA

Heart failure with preserved ejection fraction (HFpEF) is a complex clinical syndrome characterized by diastolic dysfunction and high morbidity. It presents significant challenges in diagnosis and treatment due to its heterogeneous etiology and pathophysiology. This review evaluates the efficacy and clinical utility of current and emerging pharmacological therapies for HFpEF, emphasizing personalized approaches to improve patient outcomes. A comprehensive analysis of literature was conducted to assess the role of established treatments, such as diuretics, RAAS inhibitors, and beta-blockers, alongside emerging therapies, including sodium-glucose cotransporter-2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) agonists, and novel agents like mavacamten. SGLT2 inhibitors have demonstrated significant reductions in heart failure hospitalizations and symptom burden, while GLP-1 agonists show promise in managing HFpEF with obesity or metabolic syndrome. Mineralocorticoid receptor antagonists provide benefits in selecting patients, although broader therapeutic options remain limited. Other novel agents, such as nitrates and PDE-5 inhibitors, require further validation through clinical trials. HFpEF management demands a multifaceted approach combining lifestyle interventions, optimized pharmacotherapy, and emerging therapeutic strategies. Personalized treatment plans and continued research are vital for addressing the complexities of this syndrome and improving patient outcomes.

KEY WORDS: Heart failure, diastolic; Sodium-glucose transporter 2 inhibitors; Drug therapy