CLINICAL REVIEWS Diastolic Heart Failure: A Review and Primary Care Perspective

Previously the subject of much debate, there is now consensus that diastolic heart failure (DHF) repre-sents a distinct form of heart failure. Epidemiologic data indicate that DHF is common. Indeed, there is evidence that, among elderly persons, DHF is more common than systolic heart failure (SHF). Like SHF, DHF is associated with significant morbidity, mortality, and cost; however, few clinical trials focusing on isolated DHF have been completed. Much of the treatment of DHF is based on current concepts of the pathophysiology of DHF, small clinical studies, and experience gained from treating patients with SHF. The diagnosis of DHF is clinical; data supporting the establishment of a diagnosis of DHF are limited. Differences exist in prognosis and treatment between diastolic and systolic heart failure. This article reviews diastolic heart failure with emphasis on evidence-based management, aimed at primary care physicians who routinely provide care to patients with DHF. (J Am Board Fam Pract 2005;18:189–98.) In addition to being a major cause of morbidity and mortality, congestive heart failure (CHF) is a lead-ing cause of hospitalization of elderly persons in the United States and is estimated to cost up to $40 billion per year.1 Clinical trials regarding CH