Managing HFpEF in the Nursing Home
Congestive heart failure (CHF) is one of the most common chronic conditions affecting older adults in long-term care settings. Approximately half of individuals with heart failure have a subtype known as heart failure with preserved ejection fraction (HFpEF). HFpEF occurs when the left ventricle becomes stiff and is unable to fill adequately with blood during diastole. It is termed “preserved” because the heart maintains an ejection fraction (EF) of 50% (as measured on echocardiograms) or greater despite impaired filling. HFpEF is particularly common among older adults with comorbid conditions such as hypertension, diabetes, obesity, and atrial fibrillation. For residents with a diagnosis of HFpEF, or those at risk of developing heart failure, it is important for clinical staff to understand the associated signs and symptoms, key management strategies, and the implications of this diagnosis for resident care.
Residents with HFpEF commonly experience shortness of breath during activity or when lying flat, as well as lower-extremity edema. Additional clinical findings that may warrant further evaluation by a healthcare provider include pulmonary crackles, jugular venous distention (JVD), and worsening peripheral edema. In some cases, the only indicators of clinical decline may be subtle, nonspecific changes such as decreased functional ability, increased fatigue, or alterations in mental status. Maintaining continuity of caregivers can help facilitate the early recognition of these changes, enabling timely intervention and potentially preventing avoidable hospitalizations.
Management of HFpEF focuses on treating underlying comorbidities, controlling symptoms, and preventing disease progression. Loop diuretics are commonly prescribed to manage fluid overload and maintain fluid balance. Sodium-glucose cotransporter-2 (SGLT2) inhibitors, such as empagliflozin and dapagliflozin, have been shown to reduce heart failure-related hospitalizations and are recommended for many patients with HFpEF. Additional therapies, including mineralocorticoid receptor antagonists, angiotensin receptor blockers (ARBs), and angiotensin receptor–neprilysin inhibitors (ARNIs), may be used to optimize blood pressure control and promote clinical stability. Nursing interventions remain a critical component of care and include monitoring fluid status and daily weights, performing regular focused cardiovascular and respiratory assessments, and providing ongoing education regarding dietary recommendations, fluid management, and medication adherence. Together, these strategies support symptom control, improve quality of life, and reduce the risk of exacerbations and hospitalization.
