We would like to thank Dr Satchithananda, Sister Ingram and Dr Hookey for their interest in our editorial. We welcome this opportunity to respond. We framed our discussion in the setting of left ventricular systolic dysfunction as this is where the robust evidence base for heart failure therapy has evolved. The evidence base for effective therapy for the clinical syndrome of heart failure with preserved systolic function is much weaker, with very few randomised controlled clinical trials. However, we accept that the symptomatic burden and mortality risk for those with heart failure with preserved systolic function …