Supplementary Figure S1. Diagnostic algorithm for coronary artery disease in patients with heart failure and preserved ejection fraction. (Adapted with permission from Springer from: Shah SJ. Curr Treat Options Cardiovasc Med. 2010;12(1):58-75) [45].

Supplementary Figure S2. Systemic hypertension treatment algorithm for HFpEF. (Adapted with permission from Springer from: Oktay AA, Shah SJ. Curr Cardiol Rep. 2014;16(12):545) [38].

Supplementary Figure S3. Treatment algorithm for the use of spironolactone in HFpEF. (Reproduced with permission from Springer from: Mitter SS, Shah SJ. Curr Atheroscler Rep. 2015;17(11):64) [39].

Supplementary Figure S4. University of Minnesota algorithm for the identification of HFpEF Patients through the electronic health record.

Step 1:

Daily “inpatient heart failure” list generated:

Search criteria: heart failure diagnosis OR NT-proBNP > 300 pg/ml

Step 2:

Patients moved from the “inpatient heart failure” list to the “possible HFpEF” list for MD review using the following tool:

Exclusions:

Take patients off of the “inpatient heart failure” list if any of the following in the H&P:

LVAD present

Left ventricular ejection fraction < 45 %

ESRD on hemodialysis

On hospice

End stage dementia (bed bound, nursing home only)

Pulmonary arterial hypertension (PA mean >25, PCWP<15, PVR >3 and usually on sildenafil, flolan or remodulin, or bosentan or ambrisartan) or PAH is in the history

End stage lung disease awaiting lung transplant

Severe valve stenosis or regurgitation (aortic, mitral)

“Possible HFpEF” list criteria:

If the H&P says HFpEF AND the last echo EF > 45 % à YES

If it is not clear whether they may or may not have HFpEF go to the:

Echocardiogram:

If the echo says grade II or III diastolic dysfunction with EF ≥45 %à YES

If no mention of diastolic function and EF ≥45 %, continue and look for the following:

Left atrial or right atrial enlargement

Left ventricular hypertrophy

PASP >35 mm Hg

If ANY of these àYES

If no echo variables suggestive, then go to the following areas:

Labs:

NT-BNP abnormal ever (and EF ≥ 45 %) à YES

Medications:

On diuretics (furosemide, bumetanide, torsemide) and EF ≥ 45 % à YES

If still unable to determine, check for prior right heart catheterization:

If PCWP >15 mmHg OR LVEDP >15 mmHg AND EF ≥45 % à YES