Heart Failure with Preserved Ejection Fraction (HFpEF)

Recognized by U.S. News & World Report

UT Southwestern Medical Center’s treatment for heart failure is rated as “High Performing” by U.S. News & World Report, placing us among the nation’s best hospitals in this area of care.

Heart failure with preserved ejection fraction (HFpEF) is a common form of heart failure, especially in older adults. At UT Southwestern, patients with HFpEF receive care through a specialty clinic focused on careful evaluation, personalized treatment, and long-term quality of life.

What Is HFpEF?

HFpEF is a type of heart failure that occurs when the heart muscle is less flexible than it should be. The left ventricle, the main pumping chamber, may not relax well between beats. As a result, the heart may not fill with enough blood.

Pressure can build inside the heart and in blood vessels that return blood from the lungs. This pressure rise can contribute to shortness of breath, fatigue, and fluid buildup.

HFpEF is common in older adults. Effective therapies have been limited, in part because it has many contributing factors and is not one single disease.

What Causes HFpEF?

HFpEF usually develops over time. Aging and inflammation can increase someone’s risk of developing the condition. Many long-term health conditions can also contribute to changes in the heart and blood vessels.

Conditions linked to HFpEF include:

• High blood pressure
• Obesity
• Diabetes
• Coronary artery disease
• Atrial fibrillation
• Chronic kidney disease
• Chronic obstructive pulmonary disease (COPD)
• Obstructive sleep apnea
• Anemia

What Are the Symptoms of HFpEF?

HFpEF symptoms often reflect the heart’s reduced ability to fill and respond to activity. They can build slowly and may worsen during exercise or when lying down.

Symptoms include:

• Shortness of breath with activity
• Shortness of breath at rest
• Trouble breathing when lying flat
• Fatigue or low energy
• Reduced exercise tolerance
• Swelling in the legs, ankles, or feet
• Chest discomfort

How Is HFpEF Diagnosed?

HFpEF is not the same in every patient. It can develop from different health problems and affect the heart and blood vessels in different ways. Because symptoms and test results can vary, diagnosis often includes detailed testing to confirm HFpEF and identify factors that may be driving it.

At UT Southwestern’s HFpEF clinic, doctors begin with a review of symptoms and medical history. Cardiac testing may include:

• Echocardiogram, which measures ejection fraction and assesses heart structure
• Blood tests such as natriuretic peptides (BNP/NT-proBNP), which can rise in heart failure
• Exercise or stress testing, which may reveal abnormal pressure responses
• Exercise hemodynamic assessment to help confirm HFpEF
• Cardiac catheterization in selected cases to measure pressures directly
• Cardiac magnetic resonance imaging (MRI) in selected cases to evaluate heart muscle and structure

How Is HFpEF Treated?

At UT Southwestern, HFpEF treatment is tailored to symptoms and contributing conditions. Many care plans focus on reducing fluid buildup, improving daily function, and managing related conditions.

Common approaches include:

• Diuretics to reduce fluid overload when swelling or congestion is present
• Blood pressure management
• Treatment of atrial fibrillation and other rhythm problems, when present
• Treatment of sleep apnea, when present

Some patients may also benefit from other medicines, based on clinical trial evidence and individual health needs.

Lifestyle and rehabilitation strategies may help improve symptoms and quality of life, such as:

• Supervised exercise training programs
• Weight-loss strategies for obesity-related HFpEF
• Dietary patterns that support blood pressure control, such as DASH-style eating

What Clinical Trials Are Available for HFpEF?

UT Southwestern researchers are focused on improving HFpEF treatment, and we offer numerous clinical research studies that explore new medicines, exercise and rehabilitation programs, and weight-loss approaches.

View current HFpEF clinical trials.