{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T17:48:15Z","timestamp":1792172895476,"version":"4.4.0"},"reference-count":296,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2020,3,1]],"date-time":"2020-03-01T00:00:00Z","timestamp":1583020800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"},{"start":{"date-parts":[[2020,3,5]],"date-time":"2020-03-05T00:00:00Z","timestamp":1583366400000},"content-version":"vor","delay-in-days":4,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Heart Failure Association"},{"name":"Heart Failure Association"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Making a firm diagnosis of chronic heart failure with preserved ejection fraction (HFpEF) remains a challenge. We recommend a new stepwise diagnostic process, the \u2018HFA\u2013PEFF diagnostic algorithm\u2019. Step 1 (P=Pre-test assessment) is typically performed in the ambulatory setting and includes assessment for heart failure symptoms and signs, typical clinical demographics (obesity, hypertension, diabetes mellitus, elderly, atrial fibrillation), and diagnostic laboratory tests, electrocardiogram, and echocardiography. In the absence of overt non-cardiac causes of<\/jats:p>\n                  <jats:p>breathlessness, HFpEF can be suspected if there is a normal left ventricular (LV) ejection fraction, no significant heart valve disease or cardiac ischaemia, and at least one typical risk factor. Elevated natriuretic peptides support, but normal levels do not exclude a diagnosis of HFpEF. The second step (E: Echocardiography and Natriuretic Peptide Score) requires comprehensive echocardiography and is typically performed by a cardiologist. Measures include mitral annular early diastolic velocity (e\u2032), LV filling pressure estimated using E\/e\u2032, left atrial volume index, LV mass index, LV relative wall thickness, tricuspid regurgitation velocity, LV global longitudinal systolic strain, and serum natriuretic peptide levels. Major (2 points) and Minor (1 point) criteria were defined from these measures. A score \u22655 points implies definite HFpEF; \u22641 point makes HFpEF unlikely. An intermediate score (2\u20134 points) implies diagnostic uncertainty, in which case Step 3 (F1: Functional testing) is recommended with echocardiographic or invasive haemodynamic exercise stress tests. Step 4 (F2: Final aetiology) is recommended to establish a possible specific cause of HFpEF or alternative explanations. Further research is needed for a better classification of HFpEF.<\/jats:p>","DOI":"10.1002\/ejhf.1741","type":"journal-article","created":{"date-parts":[[2020,3,5]],"date-time":"2020-03-05T04:52:20Z","timestamp":1583383940000},"page":"391-412","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":334,"title":["How to Diagnose Heart Failure with Preserved Ejection Fraction: The HFA\u2013PEFF Diagnostic Algorithm: A Consensus Recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)"],"prefix":"10.1093","volume":"22","author":[{"given":"Burkert","family":"Pieske","sequence":"first","affiliation":[{"name":"Department of Internal Medicine and Cardiology, Charit\u00e9 - Universit\u00e4tsmedizin Berlin, Campus Virchow Klinikum"},{"name":"German Center for Cardiovascular Research (DZHK), Berlin, Partner Site, Germany"},{"name":"Department of Internal Medicine and Cardiology, German Heart Institute, Berlin, Germany"},{"name":"Berlin Institute of Health (BIH), Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carsten","family":"Tsch\u00f6pe","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Cardiology, Charit\u00e9 - Universit\u00e4tsmedizin Berlin, Campus Virchow Klinikum"},{"name":"German Center for Cardiovascular Research (DZHK), Berlin, Partner Site, Germany"},{"name":"Berlin Institute of Health (BIH) Center for Regenerative Therapies (BCRT), Charite, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4775-9140","authenticated-orcid":false,"given":"Rudolf A.","family":"de Boer","sequence":"additional","affiliation":[{"name":"University Medical Centre Groningen, University of Groningen, Department of Cardiology, Groningen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan G.","family":"Fraser","sequence":"additional","affiliation":[{"name":"School of Medicine, Cardiff University, Cardiff, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan D.","family":"Anker","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Cardiology, Charit\u00e9 - Universit\u00e4tsmedizin Berlin, Campus Virchow Klinikum"},{"name":"German Center for Cardiovascular Research (DZHK), Berlin, Partner Site, Germany"},{"name":"Berlin Institute of Health (BIH) Center for Regenerative Therapies (BCRT), Charite, Berlin, Germany"},{"name":"Department of Cardiology and Pneumology, University Medicine G\u00f6ttingen (UMG), Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erwan","family":"Donal","sequence":"additional","affiliation":[{"name":"Cardiology and CIC, IT1414, CHU de Rennes LTSI, Universit\u00e9 Rennes-1, INSERM 1099, Rennes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Edelmann","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Cardiology, Charit\u00e9 - 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IKEM, Prague, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel A.","family":"Morris","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Cardiology, Charit\u00e9 - Universit\u00e4tsmedizin Berlin, Campus Virchow Klinikum"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6044-950X","authenticated-orcid":false,"given":"Eike","family":"Nagel","sequence":"additional","affiliation":[{"name":"Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt"},{"name":"German Centre for Cardiovascular Research (DZHK), Partner Site Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth","family":"Pieske-Kraigher","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Cardiology, Charit\u00e9 - Universit\u00e4tsmedizin Berlin, Campus Virchow Klinikum"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piotr","family":"Ponikowski","sequence":"additional","affiliation":[{"name":"Medical University, Clinical Military Hospital, Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott D.","family":"Solomon","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramachandran S.","family":"Vasan","sequence":"additional","affiliation":[{"name":"Section of Preventive Medicine and Epidemiology and Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5052-7332","authenticated-orcid":false,"given":"Frans H.","family":"Rutten","sequence":"additional","affiliation":[{"name":"Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriaan A.","family":"Voors","sequence":"additional","affiliation":[{"name":"University Medical Centre Groningen, University of Groningen, Department of Cardiology, Groningen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Ruschitzka","sequence":"additional","affiliation":[{"name":"University Heart Centre, University Hospital Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walter J.","family":"Paulus","sequence":"additional","affiliation":[{"name":"Department of Physiology and Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petar","family":"Seferovic","sequence":"additional","affiliation":[{"name":"University of Belgrade School of Medicine, Belgrade University Medical Center, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerasimos","family":"Filippatos","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National and Kapodistrian University of Athens Medical School; University Hospital \u201cAttikon\u201d, Athens, Greece"},{"name":"University of Cyprus, School of Medicine, Nicosia, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,3,5]]},"reference":[{"key":"2026080800465484900_ejhf1741-bib-0001","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1002\/ejhf.483","article-title":"Epidemiology of heart failure: the prevalence of heart failure and ventricular dysfunction in older adults over time. 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