PURPOSE OF REVIEW: Heart failure is a major health problem with significant 
morbidity and mortality. Although impressive advances in treatment and reduction 
in mortality have marked heart failure with reduced ejection fraction (HFrEF), 
the mortality in patients with heart failure with preserved ejection fraction 
(HFpEF), which accounts for nearly half of heart failure cases, has remained 
unchanged. This may be because of the lack of consistent diagnostic criteria and 
limited understanding of the pathophysiology of HFpEF, and thus appropriate 
treatment options.
RECENT FINDINGS: Recent data suggest that HFpEF consists of multiple 
abnormalities rather than a distinct entity. Advances in testing have improved 
diagnosis, but further validation is required. The discoveries of new 
pathological abnormalities have identified potential new drug therapy targets. 
Traditional agents with strong evidence in HFrEF have proved unsuccessful in 
HFpEF. Newer agents such as angiotensin receptor neprilysin inhibitor, 
sildenafil, and ivabradine have demonstrated benefits without improving 
mortality. Lastly, as HFpEF patients are older with more comorbidities, 
alternate endpoints to survival benefit should be considered.
SUMMARY: Although enormous strides have been made in understanding the 
pathophysiology and refining the diagnostic criteria of HFpEF, there is 
currently no pharmacological therapy with mortality benefits. Further 
characterization and the recruitment of more homogeneous patient populations 
will be essential to identify effective treatments.