The Curbsiders Internal Medicine Podcast

REBOOT: #460 Heart Failure with Preserved Ejection Fraction

121 snips
Sep 29, 2025
In this insightful discussion, Dr. Michelle Kittleson, a leading expert in heart failure at Cedars-Sinai, unpacks the complexities of heart failure with preserved ejection fraction (HFpEF). She explores key diagnostic strategies like the H2F-PEF score and the challenges of interpreting BNP levels in obese patients. The conversation also highlights the benefits of weight loss and supervised exercise, the role of SGLT2 inhibitors, and nuances in managing comorbidities. Dr. Kittleson provides practical tips for identifying when to refer patients, making this a must-listen for healthcare professionals.
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ADVICE

Interpret BNP Cautiously In Obesity

  • Don't dismiss normal BNP in obese patients with suspected HFpEF; obesity lowers BNP levels.
  • Use history, exam and JVP rather than relying solely on natriuretic peptides for diagnosis.
ADVICE

Exercise And Weight Loss Improve Outcomes

  • Prescribe structured exercise and promote weight loss; both improve quality of life and exercise capacity in HFpEF.
  • Advocate cardiac rehab and multidisciplinary care because HFpEF is a multisystem disease.
INSIGHT

HFpEF Is A Multisystem Aging Problem

  • HFpEF causes both cardiovascular and non-cardiovascular mortality roughly equally, reflecting multisystem aging contributions.
  • This demands a broader, multidisciplinary management focus beyond cardiology alone.
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