Clinical Approach to Heart Failure with Preserved Ejection Fraction (HFpEF) in South Asia: An Expert Consensus Statement.

INTRODUCTION

HFpEF accounts for 12-25% of heart failure cases in South Asia, primarily driven by hypertension, diabetes, and obesity. Late diagnosis and healthcare disparities worsen outcomes. This expert consensus aims to provide region-specific guidelines for the diagnosis, management, and prevention of HFpEF.

METHODS

A modified Delphi process with experts from five South Asian countries was conducted, informed by a literature review (2018-2024) and adapted international guidelines.

RESULTS

Recommendations include the use of an adjusted H2FPEF score (BMI > 25 kg/m²), essential echocardiographic criteria (E/e' > 9, LAVi > 34 mL/m²) for diagnosis, and SGLT2 inhibitors as first-line pharmacotherapy, with finerenone for cardio-renal protection. Emphasis on lifestyle modification, patient education, and aggressive management of comorbidities is highlighted to reduce hospitalizations.

DISCUSSION: HFpEF presents earlier and is associated with higher comorbidity in South Asia. Adaptations such as lower BMI thresholds and region-specific screening are critical. Cost and accessibility challenges persist in the use of SGLT2 inhibitors and finerenone. Public health measures and infrastructure strengthening are necessary to improve outcomes.

CONCLUSION

Early diagnosis, multidisciplinary management, and tailored treatment strategies can enhance outcomes in HFpEF in South Asia. This consensus serves as a call for regionally focused implementation to reduce the burden of HFpEF.