Heart failure with preserved ejection fraction
| Diastolic dysfunction | |
|---|---|
| In those with HFpEF, the left ventricle of the heart (large chamber on right side of the picture) is stiffened and has impaired relaxation after pumping blood out of the heart. | |
| Specialty | Cardiology |
Heart failure with preserved ejection fraction (HFpEF) is a form of heart failure in which the ejection fraction – the percentage of the volume of blood ejected from the left ventricle with each heartbeat divided by the volume of blood when the left ventricle is maximally filled – is normal, defined as greater than 50%; this may be measured by echocardiography or cardiac catheterization. Approximately half of people with heart failure have preserved ejection fraction, while the other half have a reduction in ejection fraction, called heart failure with reduced ejection fraction (HFrEF).
Risk factors for HFpEF include hypertension, hyperlipidemia, diabetes, smoking, and obstructive sleep apnea. Those with HFpEF have a higher prevalence of obesity, type 2 diabetes, hypertension, atrial fibrillation and chronic kidney disease than those with heart failure with reduced ejection fraction. The prevalence of HFpEF is expected to increase as more people develop obesity and other medical co-morbidities and risk factors such as hypertension in the future.
Adjusted for age, sex, and cause of heart failure, the mortality due to HFpEF is less than that of heart failure with reduced ejection fraction. The mortality is 15% at 1 year and 75% 5-10 years after a hospitalization for heart failure.
HFpEF is characterized by abnormal diastolic function: there is an increase in the stiffness of the left ventricle, which causes a decrease in left ventricular relaxation during diastole, with resultant increased pressure and/or impaired filling. There is an increased risk for atrial fibrillation and pulmonary hypertension.
As of 2025, no medical treatment has been proven to reduce mortality in HFpEF, however some medications have been shown to improve mortality in a subset of patients (such as those with HFpEF and obesity). Other medications have been shown to reduce hospitalizations due to HFpEF and improve symptoms.
There is controversy regarding the relationship between diastolic heart failure and HFpEF.