2026 ACC Consensus Pathway Redefines HFpEF Diagnosis, Treatment Priorities
Craig Beavers, PharmD, discusses a new American College of Cardiology expert consensus decision pathway that shifts HFpEF management from ejection fraction alone toward phenotype-driven diagnosis and treatment.
On this episode of The Tell-Tale Heart, Craig Beavers, PharmD, reviews the 2026 American College of Cardiology expert consensus decision pathway on managing heart failure with preserved ejection fraction (HFpEF), recently published in the Journal of the American College of Cardiology. The document moves diagnosis beyond a simple ejection fraction cutoff, emphasizing phenotyping tools such as the H2FPEF score and HFA-PEFF algorithm alongside recognition of HFpEF as a cardiometabolic syndrome tied to obesity, hypertension, diabetes, and chronic kidney disease. Treatment priorities include SGLT2 inhibitors as a foundational therapy across HFpEF phenotypes, an expanded role for GLP-1 receptor agonists in obesity-related HFpEF, and an elevated preference for nonsteroidal mineralocorticoid receptor antagonists like finerenone over spironolactone based on FINEARTS-HF data, alongside blood pressure optimization, atrial fibrillation rhythm management, and screening for mimickers such as ATTR amyloidosis. Beavers underscores that pharmacists are uniquely positioned to drive outcomes through medication optimization, adherence support, and care coordination across the multiple comorbidities that typically accompany HFpEF.
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