While the management of heart failure with reduced ejection fraction (HFrEF) has improved significantly in recent years, little progress has been made in finding evidence-based, effective treatments for HF with preserved ejection fraction (HFpEF).
Since large international phase III clinical trials have yielded disappointing results, treatment of HFpEF remains largely empiric. Several possible explanations for the negative HFpEF clinical trials exist, including incomplete understanding of HFpEF pathophysiology, inadequate diagnostic criteria, recruitment of patients without true HF or at early stages of the syndrome, poor matching of the therapeutic mechanisms and primary pathophysiological processes, suboptimal study designs, inadequate statistical power, or patient heterogeneity.
A group of international experts came together for a workshop, to examine new and emerging therapies in the context of specific, targeted HFpEF phenotypes where positive clinical benefit may be detected in clinical trials. Lessons learned from the past decade of research were discussed, which should help maximize the benefit of future trials.
A paper has been written based on this workshop. Better phenotyping is advocated, in light of the mentioned possible explanations of previous disappointing results. Furthermore, emerging therapies are discussed, and the cumulative experience from previous trials is reviewed, based on which approaches for the design and conduct of future HFpEF trials are suggested.
 Senni M, Paulus WJ, Gavazzi A et al., New strategies for heart failure with preserved ejection fraction: the importance of targeted therapies for heart failure phenotypes. Eur Heart J (2014) doi: 10.1093/eurheartj/ehu204 First published online: August 7, 2014
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