Indian Expert Consensus on Heart Failure with Preserved Ejection Fraction: A Phenotype-based Approach to Diagnosis and Management

 Background The burden of heart failure (HF) with preserved ejection fraction (EF) is increasing in India. Compared with Western populations, Indian patients often present at a younger age with a high burden of diabetes, chronic kidney disease, central adiposity, anemia, chronic obstructive airway disease, peripheral artery disease, and ischemic heart disease. These differences pose challenges for the implementation of existing EF-based management strategies and support the need for India-specific guidance. Objectives The objectives of this study were to develop India-specific consensus recommendations for the diagnosis, phenotypic assessment, and management of HF with preserved EF (HFpEF) across diverse healthcare settings. Methodology A modified Delphi consensus process involving 25 HF experts from India and Europe was used to formulate recommendations based on a review of contemporary evidence and structured expert voting. Results Consensus was achieved on recommendations covering disease recognition, diagnosis, phenotype-based assessment, pharmacotherapy, and models of care, with emphasis on their applicability to Indian clinical practice. The consensus recognizes emerging evidence supporting sodium–glucose cotransporter-2 inhibitors as foundational therapy, mineralocorticoid receptor antagonists, particularly finerenone, in appropriate patients, and glucagon-like peptide-1 receptor agonists in selected phenotypes of HFpEF, especially those with obesity and metabolic dysfunction. While the consensus is framed around HFpEF, it also acknowledges that much of the evidence supporting these therapies includes patients with left ventricular EF between 40% and 50%, in whom similar therapeutic benefits have been demonstrated. Conclusion This consensus provides practical and phenotype-based recommendations for the diagnosis and management of HFpEF in India. These recommendations are intended to support earlier diagnosis, facilitate implementation of evidence-based therapies, reduce therapeutic inertia, and identify priorities for future research and prospective validation.
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https://www.researchgate.net/publication/413698324_Indian_Expert_Consensus_on_Heart_Failure_with_Preserved_Ejection_Fraction_A_Phenotype-based_Approach_to_Diagnosis_and_Management


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