Management updates in heart failure with mildly reduced or preserved ejection fraction

Heart failure (HF) is a clinical syndrome characterized by structural or functional impairments in ventricular filling or the ejection of blood from the heart. In the United States, HF represents a growing public health concern, affecting an estimated 6.7 million adults 20 years or older, with prevalence expected to continue rising. Despite advances in guideline-directed medical therapy (GDMT), rates of hospitalization and mortality remain high. Therapeutic options are particularly limited for the most prevalent HF phenotypes-HF with preserved ejection fraction (HFpEF) and HF with mildly reduced ejection fraction (HFmrEF)-resulting in substantial unmet clinical need. This supplement reviews the pathophysiology, epidemiology, and staging of HF with an emphasis on HFmrEF and HFpEF, and summarizes current GDMT recommendations, including the evolving roles of SGLT2 inhibitors and mineralocorticoid receptor antagonists (MRAs). A main focus is on the safety and efficacy of finerenone, a nonsteroidal MRA, as an adjunct to standard therapy in patients with HFmrEF or HFpEF. Persistent barriers to optimal care-including challenges related to diagnostic nomenclature, coding, and access-contribute to a disproportionate economic burden associated with these HF phenotypes. Together, these considerations highlight the need for managed care strategies that facilitate appropriate initiation of therapy and access to emerging treatments to improve outcomes while addressing health care resource utilization.