Satyam (Tom) Sarma, M.D. Answers Questions On: Heart failure with preserved ejection fraction (HFpEF)
How is HFpEF different from other kinds of heart failure?
Normally when we think of heart failure we think of the heart muscle being weak. HFpEF is a kind of heart failure where the heart muscle isn't weak. With HFpEF, the heart muscle seems to be fine in terms of its ability to pump blood and squeeze, but it doesn't relax like it should. The heart becomes stiff.
The way I talk about it with my patients is that as we get older, different parts of our body become stiff. The most obvious area that we think about is stiffness in our joints. But our cardiovascular system also stiffens with age. In some patients the stiffening leads to HFpEF.
HFpEF is becoming very common and accounts for half of congestive heart failure cases.
Does HFpEF carry the same risks as other kinds of heart failure?
The overall mortality rate is fairly similar for all types of heart failure. But when you dig into it, it's different.
In people with HFpEF the heart failure itself tends not to be as lethal; things like heart attacks and strokes still occur in this group, but not more so than in the general population with similar risk factors.
What typically ends up being the biggest issue with HFpEF is the impact of symptoms. Patients aren’t able to do the things they previously could do. They can't play with their grandkids. They can't walk their dog. Even simple things like housework can cause severe shortness of breath. The disease is really limiting in terms of how it affects the overall quality of life.
What are the best treatment options for HFpEF?
Unfortunately, at this time there's no cure, and no therapies have been shown to make HFpEF better. Proven therapies to address chronic congestive heart failure in cases where the heart is weak haven’t been shown to help people with HFpEF.
That’s why I’m so interested in research. There is a great need to better understand exactly what makes the heart stiff and how this, in turn, leads to shortness of breath. It’s a complicated disease, and patients often have a number of other chronic conditions, such as obesity or lung disease, that make each case unique. In other words, one size may not fit all when it comes to understanding how this disease impacts patient’s symptoms and overall quality of life.
As we start to better understand the mechanism, we can figure out what to do to treat it. There are some current studies looking at different ways to relieve the pressure build-up, and some things in the pipeline may end up being viable in the next five to 10 years.