Treatment pathways in patients with heart failure with preserved ejection fraction and obesity: perspectives from cardiology specialists and patients

Background: Obesity, highly prevalent in patients with heart failure with preserved ejection fraction (HFpEF), may make HFpEF more difficult to diagnose by masking its signs. The aim of this study was to identify challenges patients and healthcare professionals (HCPs) face in diagnosing and treating patients with HFpEF and obesity.
Methods: An anonymous, US populationbased online survey was conducted in September 2020 among 114 patients with obesity and a selfreported diagnosis of HFpEF and 200 HCPs.
Results: In the typical medical journey, almost half of patients (45%) were diagnosed with HFpEF within one month of discussing symptoms with an HCP; however, the remaining patients waited an average of 22 months for diagnosis, most of whom (78%) received their diagnosis from a cardiologist. Most patients (65%) perceived their cardiologist as the coordinator of their HFpEF care. The treatments most recommended by cardiologists for the ongoing treatment of HFpEF included lifestyle changes (91%), diuretics (87%), beta blockers (76%), and angiotensinconverting enzyme inhibitors (71%). Heart failure specialists (29%) were more likely than general cardiology specialists (12%) to report recommending prescription weightloss medications for management of HFpEF. Most cardiologists reported not having received formal training in obesity management.
Conclusions: Cardiology specialists play a central role in the diagnosis and management of HFpEF, but optimal coordination is needed to improve obesity management in patients with HFpEF.