Protocolo terapéutico de la insuficiencia cardíaca con fracción de eyección conservada

Abstract

Heart failure with preserved left ventricular ejection fraction (HFpEF) is a heterogeneous syndrome that is usually accompanied by multiple comorbidities. Its management has prognostic implications in these patients. The comorbidities that most frequently accompany HFpEF are hypertension, coronary artery disease, atrial fibrillation, obesity, diabetes mellitus, and chronic kidney disease, among others. A healthy diet with low sodium intake, regular moderate physical exercise, and stopping smoking and alcohol use are recommended. In regard to pharmacological treatment, until recently, there was no treatment with evidence to show it reduces hospitalizations due to HF or cardiovascular mortality. Therefore, treatment was focused on controlling congestive symptoms (loop diuretics). It has now been shown that treatment with SGLT2is, GLP1-ras in patients with obesity, and mineralocorticoid receptor antagonists (MRAs) in symptomatic patients, despite optimal treatment, has decreased the incidence of cardiovascular events. Treatment with SGLT2is is recommended in all patients with HFpEF unless there are contraindications.