Comprehensive Framework of Heart Failure with Preserved Ejection Fraction Management for Hospitalists: A Scoping Review

Heart failure with preserved ejection fraction (HFpEF) accounts for nearly half of all heart failure cases and remains a major source of morbidity and hospitalization, particularly among older adults with multiple comorbidities. HFpEF is characterized by diastolic dysfunction, ventricular stiffness, and impaired filling, driven by systemic inflammation, endothelial dysfunction, and myocardial fibrosis. Management is complicated by common comorbidities such as hypertension, type 2 diabetes, atrial fibrillation, chronic kidney disease, obesity, and coronary artery disease. Recent advances have expanded treatment options, with sodium-glucose cotransporter-2 (SGLT2) inhibitors demonstrating the strongest evidence for reducing heart failure hospitalizations and cardiovascular death. Additional therapies, including angiotensin receptor-neprilysin inhibitors (ARNIs), non-steroidal mineralocorticoid receptor antagonists (e.g., finerenone), and glucagon-like peptide-1 (GLP-1) receptor agonists, show promise in selected populations. Hospitalists play a critical role in early recognition, initiation of GDMT, and comprehensive management of comorbidities. This review aims to summarize current guideline-directed medical therapy (GDMT) for HFpEF and provide a practical framework for hospital-based management.