Foundational HFpEF Therapy: A Heart Failure Cardiologist’s View

On this episode of The Tell-Tale Heart, host Craig Beavers, PharmD, is joined by Alanna Morris, MD, MSc, for a clinician’s perspective on the 2026 American College of Cardiology (ACC) expert consensus decision pathway for heart failure with preserved ejection fraction (HFpEF), published in the Journal of the American College of Cardiology. Morris and Beavers discuss why HFpEF is better understood as a multisystem syndrome intertwined with obesity, hypertension, diabetes, and chronic kidney disease than as diastolic dysfunction alone, and how clinicians can raise their index of suspicion using symptoms, comorbidities, the H2FPEF score, and natriuretic peptide testing. The conversation then turns to treatment. Morris outlines the pathway’s foundation of an SGLT2 inhibitor plus the nonsteroidal mineralocorticoid receptor antagonist finerenone, the case for initiating therapy quickly, how the FINEARTS-HF and TOPCAT data compare, and the role of GLP-1 receptor agonists in patients with HFpE