Heart failure with mildly reduced and preserved ejection fraction remains one of the biggest areas of unmet need in cardiovascular medicine.
In our recently published review (co-authored by
@jozinetm and
@GianluSava) in ESC Heart Failure, we examine the established and emerging pharmacologic options for HFmrEF and HFpEF,
The larger message is clear: the therapeutic landscape is finally becoming more actionable, but treatment still needs to be more deliberate, phenotype-aware, and evidence-driven.
A few key takeaways:
SGLT2 inhibitors now have the strongest and most consistent evidence base across EF ≥40%.
Finerenone has added important momentum as a promising option for HFmrEF/HFpEF, especially as we think more seriously about cardio-kidney-metabolic biology.
Phenotype-specific treatment matters. Obesity, CKD, diabetes, atrial fibrillation, and other comorbidities are not side notes in HFpEF. They are central to the disease.
The obesity-HFpEF space is evolving quickly, with incretins like semaglutide and tirzepatide helping push the field toward more targeted therapeutic strategies.
And importantly, there is still substantial room for progress. Ongoing studies of newer approaches, including selective MR modulation and aldosterone synthase inhibition, may help address some of the major gaps that remain.
HFpEF and HFmrEF are not therapeutic dead ends like they used to feel like just 5 years ago. But they do require us to think beyond a one-size-fits-all model.
doi.org/10.1093/eschf/xvag05…