Patient handout

Heart failure with preserved EF (HFpEF, LVEF ≥50)

PRODUCTION

1. Your condition

This handout is for heart failure with preserved ef (hfpef, lvef ≥50). Your care team identified this based on: echo lvef ≥50 with diastolic dysfunction.

Other reasons your team may use this plan: nt-probnp elevated with preserved lvef; exertional dyspnea / orthopnea / fatigue; lower-extremity edema.

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
empagliflozin	10 mg	PO	once daily	EMPEROR-Preserved (PMID 34449189): CV death/HHF HR 0.79 (0.69–0.90), total HHF HR 0.73 (0.61–0.88); event-curve separation ~2–3 wk; benefit consistent ±DM. 2023 ESC FU Class I
dapagliflozin	10 mg	PO	once daily	DELIVER (PMID 36027570): primary worsening-HF/CV-death HR 0.82 (0.73–0.92), worsening HF HR 0.79 (0.69–0.91); consistent LVEF ≥/<60; event separation ~3–4 wk. 2023 ESC FU Class I

Plan: HFpEF disease-modifying stepwise ladder (LVEF ≥50) (2022 AHA/ACC/HFSA; 2023 ESC Focused Update)

3. Your action plan

Use these zones to know what to do based on how you feel.

GREEN — All clear — at dry weight, BP at goal, baseline activity

If you have:

Weight at or within 1 kg of dry weight (ACC/AHA 2022 HF)
No new dyspnea, orthopnea, or edema (ACC/AHA 2022 HF)
BP at goal (<130/80) (ACC/AHA 2022 HF)
Usual exercise tolerance (ACC/AHA 2022 HF)

Do this:

Take all HFpEF meds as prescribed every day (ACC/AHA 2022 HF)
Sodium <2 g/day (ACC/AHA 2022 HF)
Daily weight at the same time, after voiding, in same clothing (ACC/AHA 2022 HF; HFSA 2022)
Walk / exercise per plan (Ex-DHF 2011; ACC/AHA 2022 HF)
Keep follow-up appointments (ACC/AHA 2022 HF)

YELLOW — Caution — early congestion, BP drift, or new symptoms

If you have:

Weight up 2 kg in 3 days OR 2.5 kg in a week (ACC/AHA 2022 HF; HFSA 2022)
New ankle / leg swelling (ACC/AHA 2022 HF)
Need extra pillow at night, or breathlessness on stairs you previously tolerated (ACC/AHA 2022 HF)
BP persistently >=140/90 on home monitor (ACC/AHA 2022 HF)
Increased fatigue or new palpitations (possible AF) (ESC 2021 HF)

Do this:

Take prescribed rescue diuretic dose per action plan (ACC/AHA 2022 HF)
Tighten sodium intake and hold extra fluids (ACC/AHA 2022 HF)
Recheck BP and weight in 24 h (ACC/AHA 2022 HF)
Call HF clinic / PCP within 24-48 h (ACC/AHA 2022 HF)

Call your provider if:

No improvement after 48 h of rescue diuretic (ACC/AHA 2022 HF; HFSA 2022)
New irregular pulse or palpitations (ESC 2021 HF; ACC/AHA 2022 HF)
BP ≥160/100 on repeat (ACC/AHA 2022 HF)

RED — Medical alert — severe decompensation

If you have:

Severe shortness of breath at rest (ACC/AHA 2022 HF)
Cannot lie flat / sleep due to breathlessness (ACC/AHA 2022 HF)
New chest pain or pressure (ACC/AHA 2022 HF)
Confusion, fainting, or near-fainting (ACC/AHA 2022 HF)
BP >=180/120 with headache, vision change, weakness, or chest pain (ACC/AHA 2022 HF)

Do this:

Call 911 / emergency services immediately (ACC/AHA 2022 HF)
Sit upright (ACC/AHA 2022 HF)
Do not drive yourself - call EMS (ACC/AHA 2022 HF)
Bring medication list + weight diary (ACC/AHA 2022 HF)

Call your provider if:

Any red zone symptom — go to ED now, do not wait (ACC/AHA 2022 HF)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

K >=5.5 on finerenone or steroidal MRA (FINEARTS-HF Solomon NEJM 2024)
Cr rise >0.3 mg/dL or 50% on SGLT2i / finerenone / ARB (KDIGO 2024 AKI)
BP >=180/120 with new CP, dyspnea, neuro deficit, vision change (ACC/AHA 2022 HF)(life-threatening)

5. Follow-up

Visit cadence by NYHA + recent titration; vaccinations; cardiac rehab

6. Sources

Guideline: 2022 AHA/ACC/HFSA HF Guideline (PMID 35363499/35379503) + 2023 ESC Focused Update (PMID 37622666) + EMPEROR-Preserved + DELIVER + FINEARTS-HF + TOPCAT(-Americas) + STEP-HFpEF(+DM pooled) + SUMMIT + PARAGON-HF