Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients.

Podcast Summary: EP399 - Stiff Old Hearts with Dr. Fiona Foo Part 2

Introduction: Dr. Auric Bishop, a cardiologist and CEO of the Healthy Heart Network, hosts this episode featuring Dr. Fiona Foo, an interventional and general cardiologist at Sydney Cardiology Group. This is part two of a discussion on heart failure with preserved ejection fraction (HFpEF), focusing on treatment strategies and prevention of this increasingly common condition where the heart fails to relax properly.

Key Takeaways:

• SGLT2 inhibitors (such as empagliflozin and dapagliflozin) are now first-line treatment for all types of heart failure, including HFpEF, and have been shown to reduce hospitalizations and cardiovascular death.

• Acute management of heart failure with shortness of breath involves diuretics, primarily furosemide (Lasix), to remove excess fluid and relieve symptoms quickly.

• Mineralocorticoid receptor antagonists like spironolactone and the newer finerenone help rebalance hormonal pathways disrupted by heart failure and provide long-term benefit for HFpEF patients.

• Managing underlying comorbidities—including hypertension, diabetes, obesity, and chronic kidney disease—is critical for HFpEF management, as these conditions directly contribute to disease development.

• Blood pressure control is one of the most significant preventive measures for HFpEF; a target of less than 130/80 mmHg is recommended, with lower being generally better.

• A 10% reduction in blood pressure meaningfully decreases cardiac workload over 100,000 heartbeats per day and significantly reduces heart failure hospitalization risk.

• 24-hour blood pressure monitoring provides superior data compared to single or home measurements, revealing the true daily cardiac load and helping optimize treatment targets.

• Regular exercise provides measurable benefit for HFpEF patients and should be incorporated alongside medical therapy as part of non-pharmaceutical intervention.

• Blood pressure is often neglected in clinical practice despite being a major modifiable risk factor; patients must actively monitor and manage their blood pressure rather than accept borderline readings.