Session 1 · Frame 1 of 10

The report says 63%. Her life says something changed.

58 years old; six months of reduced walking tolerance
BMI 37; hypertension; remote severe preeclampsia
NT-proBNP 88; no acute warning symptoms

Fictional Renee case scene — Fictional AI-generated scene; not patient testimony.

Facilitator notes

Open with the fictional track scene if useful, then stop the media. Ask participants to describe the clinical problem without naming a diagnosis. Invite one primary-care and one specialty perspective. Do not reveal a diagnostic answer before baseline polling. The purpose is to expose how learners use a reassuring EF and low peptide, not to make them guess a hidden fact. Ask what functional change would matter to Renee and which finding would change urgency.

Sources: ACC HFpEF consensus: practical diagnostic and management framework.

Session 1 · Frame 2 of 10

Three opening decisions

Answer independently before faculty discussion
Recognition • confirmation • alternatives
No passing requirement for baseline responses

Renee, 58, has BMI 37, progressive exertional dyspnea, EF 63% and NT-proBNP 88 pg/mL. No acute warning symptoms are present. What is the best next step?A. Attribute limitation to obesity and prescribe exercise alone.B. Review complete cardiac findings and competing causes; a low peptide does not exclude HFpEF.C. Confirm HFpEF from the BMI and symptoms.D. Close cardiac evaluation and obtain pulmonary testing only.

A complete HFA-PEFF assessment is 3 and exertional symptoms persist. Which step is most appropriate?A. Confirm HFpEF because the score is above zero.B. Assign zero to any missing variable and repeat the total.C. Arrange appropriate functional assessment or specialist evaluation.D. Repeat a resting EF in a year.

A woman with suspected HFpEF now reports new resting chest pressure and breathlessness. What should happen?A. Continue the planned exercise-test appointment next month.B. Arrange emergency assessment now.C. Try an extra diuretic dose and wait for improvement.D. Use an outpatient peptide result before deciding.

Facilitator notes

Allow about one minute per item. Use the pre items in the import file. Lock the first submitted responses before discussion, retain nonresponse separately and display the distribution without identifying learners. Do not count repeat poll clicks as new participants. The production platform, not this presenter preview, must collect the records.

Sources: ACC HFpEF consensus: practical diagnostic and management framework.

Session 1 · Frame 3 of 10

Preserved EF is one measurement

Symptoms/signs need objective cardiac evidence
Review the full echo, rhythm and clinical context
HFpEF is not synonymous with any diastolic abnormality

Facilitator notes

Explain the difference between ejection fraction and the pressure or reserve required to meet exertional demand. Ask what the EF report cannot tell us. Build a short list: filling-pressure evidence, valve disease, right-sided findings and alternate explanations. Contrast HFpEF with HFrEF and HFmrEF so participants understand why study entry criteria may cross clinical categories. Avoid a prolonged pathophysiology lecture; connect each concept to the next decision.

Sources: ACC HFpEF consensus: practical diagnostic and management framework.

Session 1 · Frame 4 of 10

Interpret the biomarker in its setting

Obesity can lower concentrations
AF and kidney dysfunction can raise concentrations
A laboratory flag is not a diagnostic conclusion

Facilitator notes

Ask faculty to explain why a single universal interpretation fails. Review the actual units, rhythm and renal context. The Reddy 2025 outpatient study supports caution in obesity, but its selected diagnostic cohorts do not establish a population screening rule. Do not replace the usual cutoff with an invented women-specific threshold. Invite participants to identify the most common false reassurance in their workflow.

Sources: Reddy et al. Natriuretic peptides in ambulatory HFpEF assessment. Circulation 2025.

Session 1 · Frame 5 of 10

Reveal: the resting workup is intermediate

No major valve lesion or clear anemia
Complete HFA-PEFF score: 3
Symptoms remain reproducible with exertion

Facilitator notes

Pause before naming a next test. Ask the panel what information is still missing and whether the answer would change treatment. Explain why missing measurements cannot be scored as normal. HFA-PEFF and H2FPEF organize probability through different inputs; selecting whichever score is higher is not a validated adjudication. Ask participants to describe a referral question in one sentence.

Sources: Pieske et al. HFA-PEFF diagnostic algorithm.

Session 1 · Frame 6 of 10

Choose testing that resolves the uncertainty

Appropriate exercise assessment may reveal exertional physiology
Inconclusive noninvasive testing may lead to specialist hemodynamics
Feasibility, expertise and patient circumstances matter

Facilitator notes

Use a progressive reveal: exercise echocardiography remains nondiagnostic, and Renee wants an explanation before committing to long-term therapy. Discuss when invasive exercise assessment is reasonable and when another targeted test is more useful. The faculty should address local access barriers and alternatives. Do not teach catheterization as obligatory for every patient with obesity or dyspnea.

Sources: Pieske et al. HFA-PEFF diagnostic algorithm.

Session 1 · Frame 7 of 10

Keep competing explanations visible

Ischemia, important valve disease and rhythm disorders
Anemia, lung disease and deconditioning
Infiltrative or other structural disease when clues suggest it

Facilitator notes

Ask the panel to name one clue that would redirect the case rather than add another generic test. A history or finding suggestive of amyloidosis, significant valve disease or pulmonary disease changes the pathway. Explain that obesity can coexist with these conditions. This discussion should make diagnostic uncertainty explicit without implying that all possible conditions are equally likely.

Sources: ACC HFpEF consensus: practical diagnostic and management framework.

Session 1 · Frame 8 of 10

The referral must return an answer

State the functional loss and unresolved question
Attach full echo, rhythm, biomarker and relevant results
Assign responsibility for the next contact

Facilitator notes

Have the PA or NP moderator read an example: persistent exertional dyspnea with obesity and hypertension, preserved EF and intermediate resting assessment; evaluate for HFpEF and mimics. Ask the specialist what would make that referral actionable. Then ask who will tell Renee the result. Discuss one practical barrier from the audience and the local steps needed to resolve it.

Sources: ACC HFpEF consensus: practical diagnostic and management framework.

Session 1 · Frame 9 of 10

Questions that change the plan

What if advanced testing is unavailable?
What if symptoms become acute?
What finding would make you change your working diagnosis?

Facilitator notes

Reserve ten minutes for actual audience questions and a moderated barrier discussion. If questions are sparse, use these prompts. New resting chest pressure, syncope or severe breathlessness triggers urgent assessment; a scheduled diagnostic test is not an acute-care plan. Record unanswered clinical questions for faculty follow-up through the host, without collecting identifiable patient histories.

Sources: ACC HFpEF consensus: practical diagnostic and management framework.

Session 1 · Frame 10 of 10

Apply the decision to a new patient

Complete the three parallel post cases
Name one change to the diagnostic workflow
Use the enduring case to revisit the reasoning

A 66-year-old woman with BMI 39 has declining walking tolerance, EF 61% and NT-proBNP 96 pg/mL. Which conclusion best guides care?A. The laboratory value makes cardiac disease unlikely enough to stop testing.B. Her EF confirms that the symptoms are noncardiac.C. The findings remain inconclusive and require structured evaluation in context.D. HFpEF is established and all HF therapies should start immediately.

Resting testing is nondiagnostic. Exercise echocardiography is also inconclusive, and knowing whether HFpEF is present would change treatment. What should be considered?A. Referral for invasive exercise hemodynamics at an experienced center.B. Averaging two different diagnostic scores.C. Using symptom response to a diuretic as diagnostic proof.D. Diagnosing HFpEF because the patient has hypertension.

A woman awaiting outpatient HFpEF testing develops severe breathlessness at rest and chest pressure. What is the best next step?A. Keep the planned outpatient test as the next step.B. Arrange emergency assessment now.C. Increase the diuretic and wait until the next morning.D. Wait for a new NT-proBNP result before escalating.

Facilitator notes

Use post items after teaching, before displaying the answer key. Allow five minutes for the three decisions and five for synthesis and evaluation. Review why the plausible wrong answers fail. Preserve the first post attempt for outcomes. Conclude with the practical action: unresolved symptoms deserve an explicit question and a plan to obtain the missing evidence. Credit and attendance rules belong to the provider.

Sources: Pieske et al. HFA-PEFF diagnostic algorithm.

Minutes	Teaching task
0–5	Three baseline decisions; first responses locked
5–15	Evidence framework
15–40	Progressive case reveal, polling and faculty reasoning
40–50	Audience questions and implementation barriers
50–55	Three parallel post-case decisions
55–60	Synthesis and evaluation