Heart Failure causes an enormous individual and societal burden of disease with severe symptoms, a reduction in activities of daily life, frequent hospitalizations and poor prognosis. The field of heart failure with reduced ejection fraction has seen substantial innovation in the past years. Novel and successful treatment regimens were established, the pharmaceutical treatment options for heart failure with preserved ejection fraction remains limited to date. Yet, promising concepts are emerging. Today we have only symptoms and risk factors-based therapeutic options, and include basically diuretics, RAAsi, and antidiabetics, respectively. A causal therapy is still missing.