Since its first formal characterization three decades ago as congestive heart failure with normal systolic function, heart failure with preserved ejection fraction (HFPEF) has emerged as an increasingly common and challenging entity within the field of heart failure. Several early studies conducted on hypertrophic and infarcted hearts demonstrated diminished diastolic left ventricular (LV) filling and led to coining of the term diastolic heart failure. Yet as our understanding of heart failure has grown, the term “diastolic heart failure” was replaced by the nomenclature “heart failure with a preserved ejection fraction” by national guidelines in part because of diverse pathophysiologic mechanisms beyond diastolic dysfunction that contribute to the observed phenotype and are potential targets for therapy. The following chapter will cover the management of patients with HFPEF. After presenting an overview of the scope and pathophysiology of the condition, we will detail the diagnostic approach and treatment options before concluding with a look at the future directions in HFPEF.