Heart failure is one of the largest public health problems. One type of heart failure, known as heart failure with preserved ejection fraction (HFpEF), is the most common type yet there are no specific therapies, with now multiple negative clinical trials leading to a call for better understanding. Of particular concern is when pulmonary hypertension complicates HFpEF (PH-HFpEF). The prevalence, diagnostic criteria, and outcomes of PH-HFpEF are poorly understood. In this study, Vanderpool et al (Pitt/HVI investigators, or however you want to say this), studied data in all patients undergoing a diagnostic procedure for PH-HFpEF between 1/19/2005 and 9/26/2012 at UPMC Presbyterian, which were linked to data extracted from the UPMC data repository via collaboration with the University of Pittsburgh Department of Medicine Analytics Center (PITT DOM Analytics Center). There were a total of 19,262 procedures performed on 10,023 unique subjects. PH-HFpEF was present in 2587 subjects, (25.8%). This study, which may be the largest of its kind yet to be reported, finds a very high prevalence of PH-HFpEF with poor outcomes and high utilization of the hospital system in terms of hospitalizations. The authors also present detailed outcomes for mortality and hospitalizations which may prove critical for future clinical trial design.