Perspective:

This study highlights the difficulty of treating patients with HFPEF; over 50,000 patients studied and no therapy has been clearly shown to provide a mortality benefit. The authors point out that a major limitation of the HFPEF studies, in general, is heterogeneity. In the trials used for this analysis, the diagnostic criteria used for HFPEF patient enrollment were not well standardized. The EF criterion for HFPEF in the individual studies ranged from >35% to >50%, and many studies did not mandate evidence of diastolic dysfunction. As such, the name applied to this population has varied over the years: diastolic heart failure, HFPEF, HF with preserved systolic function. Without having a clearly defined patient population, it is hard to draw any firm conclusions about therapeutic mortality benefit in HFPEF. Regardless, in a population of patients whose major impact on quality of life is often exercise intolerance, the ability of a therapy to improve functional capacity is clinically important. Only 6 of the 30 analyzed trials included exercise data, and some would argue that peak oxygen consumption is a better marker of exercise capacity than exercise duration. In a disease of such great prevalence, morbidity, mortality, and fiscal impact, this meta-analysis demonstrates a need for the research community to follow a static, standardized definition of the HFPEF entity, and to define the outcomes of clinical interest for future study.