A Preliminary Study for INFORMED

Eligibility Criteria

• 1. Ambulatory adults age ≥ 65 years with HFpEF, according to ACC/AHA guidelines (signs and symptoms of heart failure AND ejection fraction ≥ 50%)
• 2. Taking beta-blocker
• 1. Alternate cause(s) of HFpEF Syndrome:
• 1. Severe aortic stenosis
• 2. Moderate-severe mitral stenosis
• 3. Constrictive pericarditis
• 4. High output HF
• 5. Infiltrative cardiomyopathy
• 2. Other compelling indication(s) for beta-blocker
• 1. Prior EF \< 50%
• 2. Hypertrophic cardiomyopathy
• 3. Angina
• 4. Acute coronary syndrome, myocardial infarction, or coronary artery bypass surgery in prior 3 years
• 5. History of ventricular tachycardia/arrhythmia
• 6. Atrial arrhythmia with hospitalization for rapid ventricular response, prior 1 year
• 7. Heart rate \>100 bpm within the prior 3 months
• 8. Atrial arrhythmia with ventricular rate \>90 per minute in the prior 3 months
• 9. Systolic blood pressure readings \>160 mmHg within the prior 3 months, unless classified as white coat hypertension (and home blood pressures below 140 mmHg)
• 10. Non-cardiac indications (e.g., migraine prevention, anxiety symptom management, glaucoma, hyperthyroidism, essential tumor reduction)
• 3. Clinical instability (N-of-1 trials are appropriate for stable conditions only)
• 1. Decompensated heart failure
• 2. Hospitalization in the past 30 days
• 3. Medication changes or procedures in the prior 14 days that could confound observations/data at PI discretion
• 4. Anticipated medication changes or procedures in subsequent 3 months that could confound observations/data at PI discretion
• 5. Clinical instability from other medical issues
• 4. Estimated life expectancy \< 6 months
• 5. Moderate-severe dementia or psychiatric disorder precluding informed consent
• 6. Language barrier that will preclude informed consent and ability to comprehend study procedures
• 7. Non-compliance or inability to complete study procedures
• 8. Enrollment in a clinical trial not approved for co-enrollment
• 9. Any condition that, in the Principal Investigator or treating physician's opinion, makes the patient unsuitable for study participation