This document discusses, among other things, systems and methods to determine an indication of heart failure with preserved ejection fraction (HFpEF) of a subject using a determined change in cardiac acceleration information of the subject at exertion relative to cardiac acceleration information of the subject at rest. The system can include a signal receiver circuit configured to receive cardiac acceleration information of a subject and exertion information of the subject, and an assessment circuit configured to determine the change in cardiac acceleration information of the subject at exertion relative to cardiac acceleration information of the subject at rest, and to determine an indication of HFpEF of the subject using the determined change in cardiac acceleration information.