In HFpEF, guideline-directed medical therapy (GDMT) has what level of mortality benefit?

• A. Limited benefit
• B. Not studied
• C. Clear mortality reduction
• D. Increases mortality

Answer: (A)

In HFpEF, there isn’t a proven, robust reduction in mortality from guideline-directed medical therapy. The reason is that the heart failure with preserved ejection fraction condition is driven less by the same neurohormonal remodeling that GDMT targets in HFrEF and more by diastolic stiffness and a high burden of comorbidities. Large trials of standard HF therapies (ACE inhibitors, ARBs, beta-blockers, MRAs, etc.) have not shown a consistent, meaningful drop in death rates for HFpEF. You may see some symptom relief or small improvements in certain subgroups or hospitalizations, but a clear, consistent mortality benefit hasn’t been demonstrated. Therefore, the best description is that the mortality benefit is limited.