A Stepwise Guide to the Diagnosis and Treatment of Heart Failure With Preserved Ejection Fraction

•Heart failure with preserved ejection fraction (HFpEF) diagnosis requires the presence of heart failure symptoms, evidence of elevated filling pressures, and the absence of an alternative explanation for symptoms.•Echocardiogram assessment is used to assess for preservation in ejection fraction as well as for evidence of diastolic dysfunction.•Natriuretic peptide levels may be normal in up to 30% of patients with HFpEF, and elevated levels may be supportive, but are not required for a HFpEF diagnosis.•If noninvasive testing is equivocal for HFpEF, invasive hemodynamics either at rest or with exercise should be obtained for further evaluation.•The treatment of HFpEF is centered on limited pharmacologic therapy and several nonpharmacologic interventions.•Patients with HFpEF with refractory symptoms or those eligible for ongoing HFpEF clinical trials may benefit from referral to a HF specialist or dedicated HFpEF center.•HFpEF can be diagnosed based on a combination of clinical history, physical examination, and echocardiography data.•In certain instances, additional diagnostic testing such as exercise echocardiogram or invasive hemodynamics are important to pursue to further evaluate for HFpEF.•There are limited treatment options for HFpEF, however, this is an evolving landscape with many ongoing clinical trials.