Final aetiology

HFpEF is a heterogeneous condition with various underlying aetiologies and pathophysiological abnormalities—both cardiovascular and non-cardiovascular. Identifying the final aetiology of HFpEF should be part of the diagnostic workup as it allows for the establishment of a possible specific, secondary cause of HFpEF or alternative explanations (13, 56).

Aetiological workup may include a standard exercise stress test that could detect myocardial ischaemia, an abnormal blood pressure response to exercise, chronotropic incompetence, or supraventricular and ventricular arrhythmias. The detection of these conditions could influence management strategies (14). Other more sophisticated tools for aetiological workup are listed in Table 5 (14, 68–73). Identifying the underlying aetiology in HFpEF not only offers specific therapeutic opportunities, but is also associated with the prognosis in HFpEF.

Additional tools for the aetiological workup of cardiac dysfunction (14)

Patients with HFpEF and multiple comorbidities, non-responders to treatment, or those in need of specialised/multidisciplinary care should be referred to tertiary care for optimal management.