{
  "abstract": "Background Heart failure with preserved ejection fraction (HFpEF) poses global diagnostic and therapeutic challenges, with potential regional differences in clinical practice that remain underexplored. This study aimed to map physician-reported HFpEF diagnostic and management practices across Europe and the Middle East-North Africa (MENA) region to identify similarities, differences and opportunities for improved care.Methods An independent, academically developed survey consisting of 29 questions was designed through expert collaboration to capture detailed information on physician demographics, diagnostic strategies, screening practices, pathophysiological understanding and treatment approaches for HFpEF. The survey was validated by heart failure specialists to ensure relevance and accuracy and distributed widely through professional societies, email and social media channels to reach cardiologists, general practitioners and other physicians involved in heart failure care across Europe and MENA.Results A total of 723 physicians participated (77 from MENA, 646 from Europe). The proportion of heart failure specialists was higher in Europe (26%) than in MENA (12%, p<0.001), while general cardiologists comprised a larger share in MENA (81% vs 59%, p<0.001). Natriuretic peptide testing use was lower in MENA (82%) compared with Europe (92%, p=0.023). Pharmacotherapy preferences showed both regional similarities and differences, with SGLT2 inhibitors being the most preferred drug of choice universally. In contrast, there was a higher ranking of mineralocorticoid receptor antagonists in Europe (p=0.007) and greater reported use of angiotensin receptor-neprilysin inhibitors in MENA (p=0.03).Conclusion This large international survey offers a descriptive mapping of HFpEF care practices across Europe and MENA, revealing overall guideline alignment but also regional differences in diagnostic test use and pharmacotherapy preferences. These findings underscore the need for targeted education, improved diagnostic and therapeutic access and tailored guideline implementation to ensure equitable, evidence-based HFpEF management across diverse healthcare settings.",
  "authors": [
    {
      "affiliations": [
        "School of Medicine, Cardiff University, Cardiff, UK"
      ],
      "name": "Mohamed H Omer"
    },
    {
      "affiliations": [
        "IM Sechenov First Moscow State Medical University, Moscow, Russia"
      ],
      "name": "Anastasia Shchendrygina"
    },
    {
      "affiliations": [
        "College of Medicine, Alfaisal University, Riyadh, Riyadh Province, Saudi Arabia"
      ],
      "name": "Omar Ahmad"
    },
    {
      "affiliations": [
        "CardioVID Clinic, Pontificia Bolivariana, University of Antioquia, Medellin, Colombia"
      ],
      "name": "Clara Saldarriaga"
    },
    {
      "affiliations": [
        "CardioVID Clinic, Medellin, Colombia"
      ],
      "name": "Sydney Goldfeder de Gracia"
    },
    {
      "affiliations": [
        "Heart Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia"
      ],
      "name": "Mosaad Alhussain"
    },
    {
      "affiliations": [
        "Heart Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia"
      ],
      "name": "Najmeddine Echahidi"
    },
    {
      "affiliations": [
        "Heart Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia"
      ],
      "name": "Suleiman M Kharabsheh"
    },
    {
      "affiliations": [
        "College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia"
      ],
      "name": "Fakhr Ayoubi"
    },
    {
      "affiliations": [
        "College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia"
      ],
      "name": "Kamal Alghalayni"
    },
    {
      "affiliations": [
        "College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia"
      ],
      "name": "Jehad Alburaiki"
    },
    {
      "affiliations": [
        "Heart Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia"
      ],
      "name": "Bahaa Fadel"
    },
    {
      "affiliations": [
        "Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE"
      ],
      "name": "Feras Bader"
    },
    {
      "affiliations": [
        "Cardiology Division, Sheikh Shakhbout Medical City, Khalifa University, Abu Dhabi, UAE"
      ],
      "name": "Hadi Skouri"
    },
    {
      "affiliations": [
        "Cancer Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia"
      ],
      "name": "Mohamad Hamade"
    },
    {
      "affiliations": [
        "Department of Heart Failure and Transplantology, Department Mechanical Circulatory Support and Transplantation, National Institute of Cardiology, Warsaw, Poland"
      ],
      "name": "Marta Załęska-Kocięcka"
    },
    {
      "affiliations": [
        "Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden"
      ],
      "name": "Federica Guidetti"
    },
    {
      "affiliations": [
        "Heart Failure Department, Clinical Investigation Center, Inserm 1407, CarMeN Inserm 1060, Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon, University Claude Bernard Lyon, Lyon, France"
      ],
      "name": "Nathan Mewton"
    },
    {
      "affiliations": [
        "College of Medicine, Alfaisal University, Riyadh, Riyadh Province, Saudi Arabia",
        "Heart Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia"
      ],
      "name": "Dania Mohty"
    }
  ],
  "title": "Differences in the management of heart failure with preserved ejection fraction among physicians from Europe, the Middle East and North Africa: an international survey",
  "uid": "d9e4d08e-d688-5ebf-b307-40d37d3ab48f"
}