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Heart Failure: Heart Failure With Preserved Ejection Fraction.

The incidence and prevalence of heart failure (HF) in the United States are high, with an estimated 6.2 million cases, and these numbers are expected to increase. Age is a nonmodifiable risk factor for HF development. Hypertension, diabetes, and ischemic heart disease are modifiable risk factors that can be addressed to reduce the morbidity and mortality associated with HF. Improvements in understanding of the pathophysiology of HF have led to changes in terminology. Terms such as congestive heart failure, systolic heart failure, and diastolic heart failure should no longer be used. Currently, the ejection fraction (EF) is used to classify left-sided HF. Patients with classic HF symptoms and an EF of 50% or greater have HF with a preserved EF (HFpEF). Patients with an EF of 40% or less have HF with a reduced EF (HFrEF). Priorities in HFpEF management are symptom management and control of comorbid conditions. This includes avoidance of fluid overload, blood pressure control optimization, and atrial fibrillation management. The diagnosis of HFpEF is associated with a 22% to 65% 5-year mortality rate, with 51% to 60% of deaths due to cardiovascular causes.