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Heart Failure with Preserved Ejection

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How is HFpEF diagnosed?

Diagnosis

Diagnosing HFpEF starts with understanding your symptoms and having a doctor conduct a thorough physical exam. Doctors may check for things like fluid in the lungs, swelling in the legs, abnormal heart sounds, or changes in heartbeat.

To help confirm the diagnosis, your doctor might use established diagnostic tools, inclusive of:

Blood tests

Blood tests that measure BNP or NT‑proBNP levels are often used. These markers are usually higher in people with heart failure. If your levels are low, HFpEF is less likely.

Imaging

An echocardiogram uses sound waves to create pictures of your heart, allowing your doctor to see how well the heart is pumping and check for any stiffness. 

In some cases, scoring systems like the H2FPEF or HFA‑PEFF may be used to help make an accurate diagnosis.

Additional testing

If the diagnosis is still uncertain, additional tests — like right heart catheterization or exercise-based heart tests — may be done to check how your heart works under stress.

How is HFpEF treated?

Treatment

While there’s no one-size-fits-all cure for HFpEF, treatment focuses on easing symptoms and managing related health problems.

Lifestyle and Self-Care

Healthy lifestyle changes can make a big difference. These may include:

  • Regular exercise or joining a cardiac rehab program to build strength and improve your daily function
  • Weight loss and a heart-healthy diet, like the DASH diet, which is low in sodium and helps control blood pressure and fluid buildup

Medications

Several types of medications may be used to help manage HFpEF:

  • Diuretics (water pills) help reduce swelling and fluid buildup
  • Blood pressure medications like ACE inhibitors, ARBs, and ARNIs can help improve blood pressure and reduce stress on the heart
  • SGLT2 inhibitors (such as empagliflozin or dapagliflozin) and MRAs (such as finerenone) have been shown to reduce hospitalizations in people with HFpEF
  • GLP-1 receptor agonists have been shown to promote weight loss and improve outcomes in some patients with HFpEF

FAQs

FAQs

Typically, HFrEF is defined as an EF of 40% or less, HFpEF as 50% or greater, and HFmrEF as 41–49%.

Yes. With medication, device therapy, and lifestyle changes, EF can sometimes recover or improve.

Usually every 3–6 months after major medication changes or hospitalizations, and annually once stable.

Systolic heart failure occurs when the heart’s left side is too weak to pump blood efficiently. Diastolic heart failure is when the heart’s left side becomes too stiff to relax and fill properly between heartbeats. Both can lead to reduced blood flow to the body.

When to Seek Urgent Care

When to Seek Urgent Care

Heart failure can worsen suddenly. Seek emergency medical help or call 911 if you notice:

  • Sudden or severe shortness of breath, especially at rest
  • Chest pain or pressure that doesn’t go away
  • Fainting, dizziness, or confusion
  • Rapid heartbeat or irregular rhythm
  • Swelling that rapidly worsens or weight gain >2–3 pounds in 24 hours
 

This content has been reviewed by the following medical editors.

Dr. Parag Goyal, M.D., M.S.c

Trust NewYork-Presbyterian for Heart Failure Care

NewYork-Presbyterian’s exceptional team of cardiologists and cardiac surgeons treat more heart patients than any other hospital in the country. Contact us to learn more about our treatment options for congestive heart failure. We provide complete cardiovascular care for heart failure, coronary artery disease, congenital heart disease, and all other heart conditions.