Greetings macconsulting2,
Sorry to hear you've been diagnosed with HFpEF, although getting the diagnosis is the first step to getting the right treatment. My experience has been that starting daplaglifozin (an SGLT-2i, not cheap at all) has made a big difference. It took a good month to see it, but it really helped. I'm also on a low dose of spironolactone, which is super cheap. That did wonders for my BP and has helped my potassium stay in a better range. In some people spironolactone makes the potassium go way too high, so you should do a few blood tests when you go on it. The third drug most people with HFpEF get put on is called an ARNI, Entresto (a bit expensive) being the brand name, or just plain old valsartan (pretty cheap). I'm on valsartan, but might try entresto this month. My BP is about 105/65 these days so I can't go too fast on new meds.

The GLP-1 are the new game in town. If you have an indication for starting them. they have been really effective. They are not cheap at all, but the prices have come down a bit.

As far as lifestyle, I have a lot of trouble with exercising kicking off afib. Controlling afib, if you have it, probably with ablation, is critical. I was ablated in May and have had 2 breakthrough episodes of afib, which made me sad. I used to have afib every 1-3 weeks so it was totally worth getting ablated. That being said, if I don't exercise I get depressed, so I walk that fine line, literally. I walk about 2.5 miles every day, really slowly with a few breaks. I do yoga, lift a bit of weight and sit and do one of those pedal things you see advertised on late night TV too. Sometimes I have days when I'm short of breath just walking a short distance, but not since I've been on the SGLT-2i. I still get short of breath walking what used to be my normal speed if I walk for more than 10 minutes.

The cause of my HFpEF was my first and hopefully last covid infection. I had well controlled hypertension for a few years prior to my HFpEF, an A1C of 5.7 and a BMI of 25, swam a 1/2 mile a day, biked a lot, hiked a lot, so not exactly high risk, but certainly some risk prior to Covid. I really think preventing Covid is smart for people with HF. I wear a mask when sharing air, I give away HEPA filters to my friends and family, and we all test at family gatherings if we aren't wearing masks. I had the XBB vaccine in October of 2024, which wasn't very protective in June of 2024 when KP2 was circulating. The vaccines are certainly helpful, but they aren't updating them fast enough to keep up with all the virus that flys around. The current shot is pretty good for now. I really like Novavax better than the mRNA shots, but if you don't get a fever and aches after an mRNA shot, they are fine. For sure get a flu shot, this year is going to be a doozy. I need to get an RSV shot one of these days too.

If your diagnosis is bumming you out like it did me, you might want to consider talking to someone. I did one visit with a medical social worker and it was really helpful. Friends and family don't really understand and it felt like I was dumping on them when I was feeling poorly. The social worker gave me a ton of homework, which I've not done since I'm feeling better now, but I should do that homework so I have some resilience tools for when my heart gets sad again.

I've been a vegetarian for 49 years, but ate more sweets than I should have. I've really improved my diet and wore a stelo, a continuous glucose monitor, a few times. That was an eye opener. The big change I made was I stopped eating Amy's soup for lunch and now eat a cup of beans I make in my instant pot with a splash of apple cider vinegar and Costco no salt herb stuff. I put about 20 grams of cheese on it to make me happy. I eat a carrot or some other veggie at lunch too. Amy's had too much salt and it shot my glucose up pretty fast. Probably the crackers didn't help. I eat 1/2 as much oatmeal as I used to and made up for the calories with walnuts and berries. It still bumps up my blood glucose but I sit on my pedal thing and doom scroll on my phone after breakfast, which controls it. My dinner hasn't changed too much, maybe a little more tofu and certainly less pasta and rice. I eat a bit of chocolate most days. What I found is food makes me happy, and depriving myself too much makes me sad. The glucose monitors can drive you nuts.

I know this is a lot. The good thing about getting diagnosed now instead of say, 5 years ago, is there is some good data on what works for HFpEF. You have to pay pretty close attention to your body now, which is a pain, but for me, knowledge is power. I really don't want to ever have to go back into the hospital, which isn't realistic, but I can hope!

This link is hard to read and has way too much information...
https://www.ncbi.nlm.nih.gov/books/NBK599960/
Good luck!