For HFpEF, which statement best describes symptomatic management and mortality benefit?

• A. Diuretics relieve symptoms; RAAS inhibitors have no proven mortality benefit.
• B. RAAS inhibitors have mortality benefit in HFpEF.
• C. Digoxin improves survival in HFpEF.
• D. Beta-blockers are contraindicated in HFpEF.

Answer: (A)

In HFpEF the focus is on relieving congestion to improve symptoms. Diuretics are the mainstay for this, reducing fluid overload and improving edema and dyspnea.

Mortality benefit in HFpEF has not been proven for RAAS inhibitors (ACE inhibitors/ARBs). Large trials have not shown a mortality advantage with these drugs in HFpEF, even though they may help manage hypertension or other conditions. Digoxin hasn’t demonstrated a survival benefit in HFpEF, and beta-blockers aren’t contraindicated but also lack proven mortality benefit specific to HFpEF; they’re used when indicated for rate control or comorbidities.

So the best description is that diuretics relieve symptoms, and RAAS inhibitors have no proven mortality benefit in HFpEF.