Diastolic heart failure: what, so what and now what?

The Elephant in the Room Until two decades ago, the notion that heart failure (HF) could occur in the presence of normal ejection fraction (EF) was met with great skepticism. While most physicians could recall encounters with hypertensive elderly ladies in acute pulmonary oedema despite a normal EF, it was not until large epidemiologic studies provided evidence for the existence of this syndrome that clinicians began to acknowledge “the elephant in the room”. These epidemiologic studies have confi rmed that half of patients with HF indeed have preserved EF1-6 and that this half of the HF population are predominantly women aged over 65 years with a history of hypertension. Obesity occurs in 30% to 50% of patients, diabetes in 30% to 50% and atrial fi brillation in 20% to 40% of cases. The prevalence of renal disease is high, while the reported prevalence of coronary artery disease varies widely.7