The typical image of a patient with heart failure is of a breathless person with a large flabby heart, which contracts poorly with a reduced left ventricular ejection fraction. However, many patients, mainly elderly women, have symptoms of heart failure but their hearts are not enlarged. Echocardiography shows a relatively normal left ventricular ejection fraction but usually with some left ventricular hypertrophy. Because systolic function was thought to be normal or near normal, the term “diastolic heart failure” was coined for this group of patients. However, we now know that systolic function is not entirely normal, and the problem is not only caused by diastolic dysfunction; hence the term “heart failure with a normal ejection fraction” is more appropriate.

Recent epidemiological studies have shown that heart failure with a normal ejection fraction is now a more common cause of hospital admission than systolic heart failure in many parts of the world.1 2 Mortality is also similar for both types of heart failure.1 Yet recognition of heart failure with a normal ejection fraction is poor and few …