What Is HFpEF (Diastolic Heart Failure)?

Name: What Is HFpEF (Diastolic Heart Failure)?
Published: May 3, 2023

10 min

Medically Reviewed : Haley Uher BS, MS, ACSM-CEP, EIM is Carda Health’s Head of Clinical Exercise Physiology, a certified Clinical Exercise Physiologist with 11+ years of experience supporting patients across a wide range of cardiac conditions.

Published on :

May 3, 2023

Last updated on :

August 9, 2026

Key Takeaways
HFpEF, short for heart failure with preserved ejection fraction, is also called diastolic heart failure. The heart still squeezes normally, so its ejection fraction looks normal, but the muscle has grown stiff and cannot relax and fill properly between beats. Pressure then backs up into the lungs and body, causing breathlessness, fatigue, and swelling. HFpEF makes up about half of all heart failure. It cannot be fully cured, but a newer class of medicines called SGLT2 inhibitors, careful fluid control, treating the conditions behind it, and supervised exercise can ease symptoms and reduce hospital stays.

If your doctor said you have heart failure but also told you your heart is pumping normally, you are right to feel confused. It sounds like a contradiction. That combination has a name: heart failure with preserved ejection fraction, or HFpEF, also known as diastolic heart failure. It is one of the two main types of heart failure, and it works quite differently from the type most people picture.

What Is HFpEF?

Your heart fills with blood between beats, then squeezes to push it out. Ejection fraction is the share of blood the main pumping chamber pushes out with each beat, normally around 50 to 70 percent. In HFpEF, that number stays normal, which is what “preserved” means. The problem is not the squeeze. It is the filling. The heart muscle has become stiff and cannot relax fully, so the chamber does not fill with enough blood, and pressure backs up into the lungs and the rest of the body. That is why you can have a “normal” pumping number and still have real heart failure. HFpEF accounts for roughly half of all heart failure cases.

Why HFpEF Is Different From HFrEF

Most people picture heart failure as a weak heart that cannot pump. That is the other main type, heart failure with reduced ejection fraction (HFrEF). HFpEF is almost the mirror image: the pump is strong, but the heart is too stiff to fill. The distinction matters because the two types are treated differently, and several medicines that help the weak-pump type do not work the same way in HFpEF.

Feature	HFpEF (preserved EF)	HFrEF (reduced EF)
The core problem	The heart is stiff and cannot relax and fill	The heart is weak and cannot squeeze with enough force
Ejection fraction	Normal, usually 50% or higher	Reduced, usually 40% or lower
Simple analogy	A stiff container that is hard to fill	A weakened pump
Who it often affects	Older adults; tied to high blood pressure, obesity, diabetes, and atrial fibrillation	Often follows a heart attack or other damage to the heart muscle
Main treatments	SGLT2 inhibitors, fluid control, treating the root conditions	A larger set of proven medicines that strengthen the pump

For a closer side-by-side look at the two types, see our guide to systolic vs. diastolic heart failure.

Symptoms of HFpEF

Because fluid backs up when the heart cannot fill properly, HFpEF symptoms tend to center on congestion and reduced stamina:

Shortness of breath, especially with activity or when lying flat
Fatigue and a reduced ability to exercise
Swelling in the legs, ankles, feet, or abdomen
Rapid weight gain from fluid buildup
Coughing or wheezing, particularly when lying down

These overlap with other types of heart failure, so they cannot tell you which type you have on their own. For a fuller look at warning signs, see our guide to heart failure symptoms.

What Causes HFpEF and Who Is at Risk

HFpEF usually develops slowly as long-term stress stiffens the heart muscle. The most common contributors are high blood pressure (the leading one), obesity, type 2 diabetes, atrial fibrillation, chronic kidney disease, and older age. Less often, heart valve disease or a thickened heart muscle (hypertrophic cardiomyopathy) plays a role. Because so many of these conditions travel together, HFpEF is often as much a whole-body problem as a heart problem, which is exactly why treatment focuses so heavily on the conditions behind it.

How HFpEF Is Diagnosed

Diagnosing HFpEF can be tricky precisely because the ejection fraction looks normal, so the usual headline number does not reveal the problem. Doctors put several pieces together:

Echocardiogram: an ultrasound of the heart that shows how well it relaxes and fills and how stiff the muscle is, even when the pumping fraction is normal. This is the cornerstone test.
Blood tests: natriuretic peptides (BNP or NT-proBNP) can signal that the heart is under strain, and other labs check for contributing conditions.
Electrocardiogram (ECG): records the heart’s rhythm and can flag issues such as atrial fibrillation.
Cardiac catheterization: in some cases, a thin tube measures the pressures inside the heart directly, the most definitive way to confirm high filling pressures.

What Helps: Treating HFpEF in 2026

For years, HFpEF was frustrating to treat because medicines that work for the weak-pump type did not show the same benefit here. That has finally changed, and the outlook is more hopeful than it used to be.

SGLT2 Inhibitors, the Recent Breakthrough

The biggest advance is a class of medicines called SGLT2 inhibitors, such as empagliflozin and dapagliflozin. Originally developed for diabetes, they were shown in two large trials, EMPEROR-Preserved and DELIVER, to reduce heart failure hospitalizations and cardiovascular death in people with HFpEF, whether or not they have diabetes. On the strength of that evidence, the 2022 AHA/ACC/HFSA heart failure guideline recommends them for HFpEF, and for many patients they are now a cornerstone of treatment.

Managing Fluid and the Conditions Behind It

Diuretics, or water pills, remain important for relieving the fluid buildup that causes breathlessness and swelling. Just as important is treating the conditions that drive HFpEF: controlling blood pressure, managing weight and diabetes, treating atrial fibrillation, and addressing sleep apnea. Because HFpEF is so tied to these factors, getting them under control is often where the biggest gains come from. A lower-sodium, heart-friendly eating pattern supports all of this, as covered in our guide to a heart failure diet.

Exercise and Cardiac Rehab

It is natural to fear activity when your heart is involved, but for most people with HFpEF, supervised exercise helps, and studies show structured training improves how far and how comfortably people can move. Cardiac rehab for heart failure offers this safely, combining monitored exercise, education, and support in one program. Carda Health delivers virtual cardiac rehab from home, with live, supervised sessions and real-time heart monitoring, so you can rebuild strength and confidence without the commute. Always check with your care team before starting a new exercise program.

Living With HFpEF and the Outlook

HFpEF is a long-term condition. Like other forms of heart failure, it cannot be fully reversed, but it can be managed well, and the newer treatments have genuinely improved the outlook. The people who do best tend to stay on their medications, keep their blood pressure and weight in range, move regularly, weigh themselves daily to catch fluid buildup early, and keep their care team in the loop. Small, steady habits add up to fewer symptoms and fewer hospital visits.

The Bottom Line

HFpEF, or diastolic heart failure, is the type where the heart pumps normally but is too stiff to fill, and it accounts for about half of all heart failure. The encouraging news is that it is no longer a condition without options. Between SGLT2 inhibitors, careful fluid and risk-factor control, and supervised exercise, most people can ease their symptoms, lower their risk of hospital stays, and keep living full lives.

Frequently Asked Questions

Is HFpEF the same as diastolic heart failure?

Yes. HFpEF (heart failure with preserved ejection fraction) is the current clinical term for what used to be called diastolic heart failure. Both describe a heart that pumps with a normal ejection fraction but is too stiff to relax and fill properly.

What is the life expectancy with HFpEF?

There is no single answer. HFpEF is a serious condition, but the outlook varies widely depending on your age, the conditions behind it, and how well they are controlled. Modern treatments and good risk-factor management have improved the picture. Your care team can give you the most realistic sense of your own situation.

Can HFpEF be reversed or cured?

There is no complete cure, but HFpEF can be managed well, and some people improve meaningfully when the conditions driving it, such as high blood pressure or excess weight, are brought under control. We explore this more in our guide to whether heart failure can be reversed.

What is the best treatment for HFpEF?

Treatment is individualized, but for many people it now centers on an SGLT2 inhibitor, diuretics to control fluid, and active treatment of the conditions behind HFpEF, alongside supervised exercise. Your care team will tailor the plan to you.

What causes HFpEF?

The most common causes are high blood pressure, obesity, type 2 diabetes, atrial fibrillation, chronic kidney disease, and aging. Valve disease and a thickened heart muscle can also contribute.

Is HFpEF better or worse than HFrEF?

Neither is simply better or worse. They are different problems, a stiff heart versus a weak one, and both are serious and carry a real risk of hospitalization. What matters most is getting the right treatment for your type and staying consistent with it.