Heart failure (HF) with preserved ejection fraction (HFpEF) is the most rapidly increasing form of HF, occurs primarily in older women, and is associated with high rates of morbidity, mortality, and health care expenditures. In the highest age decile (≥90 years old), nearly all patients with HFpEF. As our understanding of the disease has grown in the last few years, we now know that HFpEF is a systemic disorder influenced by aging processes. The involvement of this broad collection of abnormalities in HFpEF, the recognition of the high frequency and impact of noncardiac comorbidities, and systemic, multiorgan involvement, and its nearly exclusive existence in older persons, has led to the recognition of HFpEF as a true geriatric syndrome. Most of the conventional therapeutics used in other cardiac diseases have failed to improve HFpEF patient outcomes significantly. Several recent studies have evaluated exercise training (ET) as a therapeutic management strategy in patients with HFpEF. Although these studies were not designed to address clinical endpoints, such as HF hospitalizations and mortality, they have shown that ET is a safe and effective intervention to improve peak oxygen consumption, physical function, and quality of life in clinically stable HF patients. Recently, a progressive, multidomain physical rehabilitation study among older adults showed that it is feasible in older patients with acute decompensated HF who have high frailty and comorbidities and showed improvement in physical function. However, the lack of Centers for Medicare and Medicaid Services coverage can be a major barrier to formal cardiac rehabilitation in older HFpEF patients. Unfortunately, insistence upon demonstration of mortality improvement before approving reimbursement overlooks the valuable and demonstrated benefits of physical function and life quality.

射血分数保留的心力衰竭 (HF) (HFpEF) 是 HF 增长最快的形式，主要发生在老年女性中，并且与高发病率、死亡率和医疗保健支出相关。在最高年龄十分位数（≥90 岁）中，几乎所有 HFpEF 患者。随着我们对这种疾病的了解在过去几年中不断加深，我们现在知道 HFpEF 是一种受衰老过程影响的全身性疾病。HFpEF 的这一广泛异常集合的参与、非心脏合并症的高频率和影响以及全身性、多器官受累及其几乎只存在于老年人中，已导致人们将 HFpEF 视为真正的老年综合征. 大多数用于其他心脏疾病的常规疗法未能显着改善 HFpEF 患者的预后。最近的几项研究评估了运动训练 (ET) 作为 HFpEF 患者的治疗管理策略。尽管这些研究并非旨在解决临床终点，例如 HF 住院和死亡率，但它们表明，ET 是一种安全有效的干预措施，可改善临床稳定的 HF 患者的峰值耗氧量、身体机能和生活质量。最近，一项针对老年人的渐进式多领域身体康复研究表明，对于具有高度虚弱和合并症且身体功能有所改善的急性失代偿性 HF 老年患者是可行的。然而，缺乏医疗保险和医疗补助服务中心的覆盖范围可能是老年 HFpEF 患者正式心脏康复的主要障碍。不幸的是，在批准报销之前坚持证明死亡率有所改善，忽视了身体机能和生活质量的宝贵和已证明的好处。