Physicians must identify different phenotypes in patients with HFpEF to determine best evaluation and treatment options

Hector R. Cajigas, MD, FCCP
Hector R. Cajigas, MD, FCCP

Not all patients with heart failure with preserved ejection fraction (HFpEF) are the same, emphasized Hector R. Cajigas, MD, FCCP, who will be chairing the session Heart Failure with Preserved Ejection Fraction: Many Faces, Same Disease on Tuesday. The case-based session starts at 7:30am in room 210AB of the convention center.

“Patients have to be studied in detail,” Dr. Cajigas said. “They deserve a thorough evaluation, despite HFpEF being a common condition. It is a very disabling disease, and patients lose quantity and quality of life.”

With aging population and current trends of increased prevalence of chronic diseases, HFpEF is expected to rise to epidemic proportions. The prevalence of HFpEF is so high that it must be considered one of the main diagnoses in patients with a history of shortness of breath or changes in their exercise capacity that cannot be clearly explained otherwise.

“It’s foreseen to be worse in the years to come,” said Dr. Cajigas, a pulmonologist at the Mayo Clinic. “We want to make sure general pulmonologists and cardiologists can recognize some of the minute aspects of this disease that can help them diagnose as well as treat in a much more opportune basis.”

Obesity, diabetes, and aging are major inclusion factors in this condition that make the prognosis worse, but also make the recognition of HFpEF more obvious. A better understanding of clinical and/or biological phenotypes—that not everyone with HFpEF has the same characteristics, risk factors, or the same outcomes—also affects the type of treatment.

“It’s almost like genotyping … identifying and studying different genes for a disease that you know is independent of others or different,” Dr. Cajigas said. “In this case, it’s recognition of different aspects of the disease that can actually divide patients into different groups that have to be placed in separate potential evaluation and treatment categories because the outcomes are going to be different.”

Dr. Cajigas said a knowledgeable panel of physicians, who are experienced in this field, will review case-based scenarios with challenging phenotypes of HFpEF common in clinical practice.

“As an example, I specialize in pulmonary vascular diseases, so when we encounter a patient with pulmonary hypertension associated with HFpEF, the prognosis of both heart failure and pulmonary hypertension leads to worse outcomes,” he added. “We may not treat this patient radically different, but we have to be aware of what the potential options are in the pipeline of evaluation and treatment for this particular scenario. We have to dedicate significant effort to understand these cases comprehensively. Most importantly, we have to foster the understanding that multidisciplinary approach and inclusion in research trials are paramount to advance our knowledge to help alleviate suffering arising from this common and devastating disease.”