Summary

• Refers to the clinical syndrome of heart failure with symptoms of pulmonary and peripheral congestion in the presence of normal left-ventricular systolic function and increased diastolic filling pressures.
• Accounts for about 50% of all patients with heart failure, and carries a similar prognosis.
• The most common risk factors are advanced age, female gender, hypertension, obesity, chronic kidney disease, diabetes mellitus, and coronary artery disease.
• Patients may present with acute decompensated heart failure and are generally managed with diuresis, blood pressure control, and treatment of ischaemia and tachyarrhythmia, when present.
• No therapy has been shown to improve survival in randomised control trials. Risk factor modification is still the cornerstone of long-term management.