#HFpEF pearl of the day: Once the Dx of HFpEF is made, the 1st step is looking for and Rx'ing congestion, then Rx'ing comorbidities, and then exercise/weight loss program. I use sequential nephron blockade to minimize loop diuretic dose, always try to use MRAs when possible. 
If strictly following TOPCAT protocol for MRA use in HFpEF, here is an algorithm published here (with @SumeetMitter): pubmed.ncbi.nlm.nih.gov/26408016/
MRAs can also be very useful for patients with HFpEF on 3+ anti-HTN meds. Hyperaldo state can be unmasked with MRA treatment. I've had patients on 3-4 drugs for HTN come off of all or most of them after starting MRA treatment.
In the HFpEF management algorithm above, for treating HFpEF comorbidities: concomitant lung disease (e.g., COPD, ILD) is common and difficult to treat. O2 sat can ⬇️⬇️ with even mild pulmonary venous congestion b/c of poor lung reserve, so maintaining euvolemia very important.
Implantable hemodynamic monitoring can reduce respiratory hospitalizations in HF patients, as seen with #CardioMEMS. See: ncbi.nlm.nih.gov/pmc/articles/P…
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