Treatment

• treatment of diastolic heart failure (DHF) (heart failure with preserved left ventricular systolic ejection fraction (HFPEF)) is unsatisfactory
  • systolic hypertension should be treated to achieve adequate blood pressure control (1)
  • when fluid retention is present diuretics (frusemide or thiazide) have been shown to improve symptoms (1)
    • if the diagnosis has been made, patients can be started on low to medium dose of loop diuretics e.g. - less than 80mg of furosemide per day (2)
  • coronary revascularisation should be considered if there is evidence of reversible myocardial ischaemia
  • angiotensin converting enzyme inhibitors and angiotensin receptor blockers have been shown to improve symptoms and quality of life in patients with DHF, but do not reduce mortality (1)
  • aldosterone antagonists reduce cardiac fibrosis and are also effective anti-hypertensives (1)
  • advice on life-style and dietary changes given to patients with systolic heart failure (e.g. low salt intake) may also be helpful for patients with DHF

Notes:

• in the management of HFPEF treatment of comorbid conditions such as hypertension, myocardial ischemia and diabetes mellitus is thought to be important (2,3)
• patients who do not respond to loop diuretics should be referred to a specialist for further management (2).
• verapamil in HFPEF
  • two very small studies with less than 30 patients in each have shown that verapamil is helpful in improving exercise capacity and symptoms in HFPEF patients (3)

Reference:

• 1) BHF Factfile 4/2010. Diastolic Heart Failure.
• 2) National Institute for Health and Clinical Excellence (NICE) 2010. Chronic heart failure. National clinical guideline for diagnosis and management in primary and secondary care
• 3) European Society of Cardiology (ESC) 2008. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008