Diagnostic and therapeutic practice for Heart Failure with preserved ejection fraction around the world: an international survey

Background and aims: There is a gap in knowledge about implementing diagnostic tools and therapy for heart failure with preserved ejection fraction (HFpEF) in clinical practice. This survey aimed to assess real-world practice in HFpEF diagnosis and treatment in the international medical community. Methods: An independent academic web-based 29-question survey was designed by a group of heart failure specialists and posted by email and through scientific societies and social networks to a broad community of physicians worldwide. Results: 1.460 physicians from 95 countries answered the survey, with a mean age of 42.2±10.4 years, 39.4 % females, and 85.1% were cardiologists. The left ventricular ejection fraction cut-off value selected for HFpEF diagnosis was 50% for 89% of participants. The scores for the probability of diagnosis of HFpEF were used only by 47.2%, and H2FPEF was the most used score (31%). Natriuretic peptides were used by 87.4% of participants for the diagnostic workup, while the diastolic stress test was only used by 26.2%. 54.4% of participants chose SGLT2 inhibitors as their first drug treatment, followed by diuretics (18.6%) and ACE inhibitors (8.4%). Conclusions: In an international academic survey on HFpEF management, the criteria for screening and diagnosis of HFpEF patients remain aligned with classic international guidelines with a low use of diagnostic scores. SGLT2i is the leading therapeutic drug class used for this heterogeneous patient population. These results raise the need to improve education and awareness on diagnosing and managing HFpEF patients.