HFpEF Diagnosed
LVEF ≥50% + elevated filling pressures
- HFA-PEFF score ≥5
- or Invasive confirmation
All Pathways
CardiologyManagement
HFpEF Management (ESC 2023)
HFpEF Management (ESC 2023): HFpEF Diagnosed → SGLT2 Inhibitor (Class I) → KEY: HFpEF ≠ HFrEF → Comorbidity Management → If AFib Present.
Pathway Overview
9 steps
Algorithm Steps
9 total
01Start 02Action SGLT2 Inhibitor (Class I)
ONLY Class I drug therapy for HFpEF
- Dapagliflozin 10mg OR Empagliflozin 10mg
- Regardless of diabetes status
- EMPEROR-Preserved, DELIVER trials
- Reduces HF hospitalization + CV death
03Warning KEY: HFpEF ≠ HFrEF
Different evidence base
- No quadruple therapy
- MRA, ARNI: limited evidence
- Focus on comorbidities
04Action Comorbidity Management
PRIMARY treatment strategy
- Hypertension - tight control
- Atrial fibrillation - rate/rhythm
- Coronary artery disease
- Obesity - weight management
- Diabetes - optimal glycemic control
- Iron deficiency - IV iron
05Action If AFib Present
Rhythm control may help
- Rate or rhythm control
- Anticoagulation
- Consider ablation for symptoms
06Action Exercise Training
Class I recommendation
- Supervised cardiac rehab
- Improves functional capacity
- Improves quality of life
07Outcome Follow-Up
Regular reassessment, optimize comorbidities
08Action Other Therapies (Limited Evidence)
Consider on individual basis
- MRA: Some benefit (Class IIb)
- ARB/ARNI: Inconsistent data
- Beta-blockers: For rate control only
- Path rejoins step 06Shared downstream outcome
09Action Diuretics for Congestion
Symptom relief
- Loop diuretics for volume overload
- Dose to euvolemia
- Monitor for over-diuresis
- Path rejoins step 04Shared downstream outcome
Guideline Source
2023 ESC Focused Update on Heart Failure
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- HFA-PEFF diagnostic criteria not detailed
- SGLT2i is ONLY Class I therapy (different from HFrEF)
- Comorbidity management is primary focus
Contraindicated Populations
pediatric
Applicable Regions
EUUS
EU: ESC 2023 - SGLT2i Class I for HFpEF
US: ACC/AHA similar recommendations
Version 1Next review: 2027-08-01
Next steps
Finish the workflow by opening the most relevant calculator, then convert the session into a live account when you are ready.
Related Resources
Frequently Asked Questions
What is the HFpEF Management (ESC 2023)?
The HFpEF Management (ESC 2023) is a management clinical algorithm for Cardiology. It provides a structured decision tree to guide clinical decision-making, based on 2023 ESC Focused Update on Heart Failure.
What guideline is the HFpEF Management (ESC 2023) based on?
This algorithm is based on 2023 ESC Focused Update on Heart Failure (DOI: 10.1093/eurheartj/ehad195).
What are the limitations of the HFpEF Management (ESC 2023)?
Known limitations include: HFA-PEFF diagnostic criteria not detailed; SGLT2i is ONLY Class I therapy (different from HFrEF); Comorbidity management is primary focus. Individual patient factors may require deviation from these recommendations.
Get AI-Powered Analysis Alongside This Algorithm
In AttendMe.ai, the HFpEF Management (ESC 2023) appears automatically when your clinical question matches — alongside evidence from 3M+ peer-reviewed articles.
Try AttendMe Free