The neglected issue of cardiac amyloidosis in trials on heart failure with preserved ejection fraction in the elderly

Heart failure with preserved ejection fraction (HFpEF) is a major public health problem increasing mortality, morbidity and impaired quality of life. To date, none of the recommended treatments for heart failure (HF) with reduced ejection fraction (EF) has shown to reduce morbidity and mortality in patients with HFpEF.1 Indeed, as observed in previous studies with angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARBs), beta-blockers (BB) and mineralocorticoid receptor antagonist (MRA), also the recently published PARAGON-HF trial failed to show a significant benefit of sacubitril/valsartan in patients with HFpEF in terms of hospitalizations for HF and death from cardiovascular causes, with the only exceptions of patients with an EF ranging from 45% to 57% and women.2