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Electrolyte and Hormonal Disorders / Heart Failure Treatment and Management · Journal article
Heart Failure Reviews · August 7, 2026
A consensus or society position rather than new primary data.
This narrative review documents a paradigm shift in HFmrEF and HFpEF management, supported by recent RCT evidence, moving from symptom-focused care to evidence-based pharmacotherapy with SGLT2 inhibitors as a cornerstone, augmented by nsMRAs and GLP-1 receptor agonists. The source reflects current guideline positions in Europe and America and advocates for combination therapy to optimize outcomes, but does not itself present primary efficacy data or comparisons between approaches.
Narrative review. Patients with heart failure with mildly reduced ejection fraction (HFmrEF) and preserved ejection fraction (HFpEF). Intervention: SGLT2 inhibitors, non-steroidal mineralocorticoid receptor antagonists (nsMRA), and glucagon-like peptide-1 receptor agonists (GLP-1 RA).
SGLT2 inhibitors are now a main pillar of HFmrEF and HFpEF treatment following definitive RCT results Non-steroidal MRAs and GLP-1 receptor agonists are emerging as effective treatments and may prevent progression of cardiovascular-kidney-metabolic syndrome Over two decades of prior RCTs of neurohormonal blockade failed to definitively demonstrate clinical benefits for HFmrEF and HFpEF
No discussion of adverse event profiles, contraindications, or patient selection criteria is provided.
Clinicians should recognize that contemporary guideline-endorsed management of HFmrEF and HFpEF now includes SGLT2 inhibitors as first-line pharmacotherapy, with consideration of nsMRAs and GLP-1 receptor agonists as evidence accumulates. The source encourages a shift from symptom management alone to multi-agent therapy targeting underlying pathophysiology.
A narrative review synthesizing evidence from multiple RCTs to support contemporary treatment recommendations for HFmrEF and HFpEF, reflecting current European and American guideline positions.
As stated by the source record.
Clinicians should recognize that contemporary guideline-endorsed management of HFmrEF and HFpEF now includes SGLT2 inhibitors as first-line pharmacotherapy, with consideration of nsMRAs and GLP-1 receptor agonists as evidence accumulates. The source encourages a shift from symptom management alone to multi-agent therapy targeting underlying pathophysiology.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
What is missing. This record has no reported figures. That is a gap in the analysis, not a judgement about the study.
Treatment for heart failure with mildly reduced ejection fraction (HFmrEF) and preserved ejection fraction (HFpEF) has evolved significantly in recent years. This period of therapeutic progress follows a span of over two decades during which randomized controlled trials (RCTs) of neurohormonal blockade and other therapies failed to definitively demonstrate clinical benefits. As such, traditionally, management guidelines for HFmrEF and HFpEF were limited to recommendations focused on optimization of volume status with diuretics, management of comorbidities, and consideration of certain medications such as angiotensin receptor-neprilysin inhibitor (ARNi) or steroidal mineralocorticoid receptor antagonists (MRA) to subsets of patients. After definitive results from multiple RCTs, sodium-glucose cotransporter 2 inhibitors (SGLT2i) are currently a main pillar in treating HFmrEF and HFpEF in European and American guidelines. However, other therapies, including non-steroidal mineralocorticoid receptor antagonists (nsMRA) and glucagon-like peptide-1 receptor agonists (GLP-1 RA), are proving to be additional effective treatments for HFmrEF and HFpEF and preventing the progression of cardiovascular-kidney-metabolic (CKM) syndrome. There is now increasing justification for combining multiple proven treatments for HFmrEF and HFpEF to maximize potential benefits. Treatment for different types of heart failure has improved significantly in recent years. For many years, there were few treatments that clearly helped people with heart failure whose heart still pumps normally or nearly normally. Care mainly focused on treating symptoms, helping the body remove excess fluid, and managing related health conditions such as high blood pressure, diabetes, and obesity. Today, research has expanded the available treatment options. One important group of medicines helps the body remove excess sugar and salt through the urine, which also reduces excess fluid and lowers the strain on the heart. Newer studies have shown that medicines that block the effects of a hormone called mineralocorticoid can improve outcomes while causing fewer side effects than older steroid-based treatments. For people who also have obesity, another newer group of medicines that acts on natural gut hormones has been shown to improve symptoms, physical activity, and quality of life. Overall, using a combination of these newer treatments may help people with heart failure whose heart still pumps normally or nearly normally feel better, improve their quality of life, and achieve better long-term health outcomes.
Taken from the source record, never inferred. Follow any of these and new work involving them reaches your briefing.