Log in to MyACC
Diagnostic Algorithms for Heart Failure With Preserved Ejection Fraction
Quick Takes
- Higher scores of H2FPEF and HFA-PEFF were associated with increased risk of HF hospitalization or death in those with unexplained dyspnea.
- Clinicians may have a higher degree of suspicion in detecting HFpEF in individuals with unexplained dyspnea using these two algorithms in combination.
- These scores need to be validated in a broader community-based sample of patients with dyspnea in which HFpEF or non-HFpEF status is determined definitively by invasive hemodynamic assessment.
Study Questions:
What are the characteristics and risk of adverse outcomes associated with the H2FPEF and HFA-PEFF scores among participants in the community with unexplained dyspnea?
Methods:
The investigators included 4,892 ARIC (Atherosclerosis Risk In Communities) study participants 67-90 years of age at visit 5 (2011 to 2013) without other common cardiopulmonary causes of dyspnea. Participants were categorized as asymptomatic (76.6%), having known heart failure with preserved ejection fraction (HFpEF) (10.3%), and having tertiles of each score among those with ≥ moderate, self-reported dyspnea (13.1%). The primary outcome was HF hospitalization or death. Cox proportional hazards models and Harrell’s C statistics were used to assess the association of group assignment with outcomes post-visit.
Results:
Mean age was 75 ± 5 years, 58% were women, and 22% were black. After a mean follow-up of 5.3 ± 1.2 years, rates of HF hospitalization or death per 1,000 person-years for asymptomatic and known HFpEF were 20.7 (95% confidence interval [CI], 18.9-22.7) and 71.6 (95% CI, 61.6-83.3), respectively. Among 641 participants with unexplained dyspnea, rates were 27.7 (95% CI, 18.2-42.1), 44.9 (95% CI, 34.9-57.7), and 47.3 (95% CI, 36.5-61.3) (tertiles of H2FPEF score) and 31.8 (95% CI, 20.3-49.9), 32.4 (95% CI, 23.4-44.9), and 54.3 (95% CI, 43.8-67.3) (tertiles of HFA-PEFF score). Participants with unexplained dyspnea and scores above the diagnostic threshold suggested for each algorithm, H2FPEF score ≥6 and HFA-PEFF score ≥5, had equivalent risk of HF hospitalization or death compared with known HFpEF. Among those with unexplained dyspnea, 28% had “discordant” findings (only high risk by 1 algorithm), while 4% were high risk by both.
Conclusions:
The authors concluded that individuals with unexplained dyspnea and higher H2FPEF or HFA-PEFF scores face substantial risks of HF hospitalization or death.
Perspective:
This epidemiological study reports that higher scores of H2FPEF and HFA-PEFF were associated with increased risk of incident HF hospitalization or death in those with unexplained dyspnea. Furthermore, scores above both diagnostic thresholds on both, identified participants with unexplained dyspnea at equivalent risk to those with known HFpEF. Overall, these data suggest that clinicians have a higher degree of suspicion in detecting HFpEF in individuals with unexplained dyspnea using these two algorithms in combination. Given limitations of the current study design, validation of the algorithms in a broader community-based sample, using patients with dyspnea in which HFpEF or non-HFpEF status is determined definitively by invasive assessment, is indicated prior to widespread clinical application of the scores.
Clinical Topics: Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Acute Heart Failure
Keywords: Algorithms, Atherosclerosis, Diagnostic Imaging, Dyspnea, Heart Failure, Hospitalization, Risk Factors, Secondary Prevention, Stroke Volume
< Back to Listings
