Predictive value of H 2 FPEF score in patients with heart failure with preserved ejection fraction

Aims: The H2FPEF score is a convenient risk stratification tool for diagnosing heart failure with preserved ejection fraction (HFpEF). This study examined the value of the H2FPEF score for predicting all-cause mortality and rehospitalization in HFpEF patients.

Methods and results: This was a retrospective cohort study of patients diagnosed with HFpEF by echocardiography at a single tertiary centre between 1 January 2015 and 30 April 2018. According to the H2FPEF score, the subjects were divided into low (0–1 points), intermediate (2–5 points), and high (6–9 points) score groups. The primary outcomes were all-cause mortality and rehospitalization. A total of 476 patients (mean age: 70.5 ± 8.4 years, 60.7% female) were included. Of these, 47 (9.9%), 262 (55.0%), and 167 (35.1%) were classified into the low, intermediate, and high score groups, respectively. Over a mean follow-up of 27.5 months, 63 patients (13.2%) died, and 311 patients (65.3%) were rehospitalized. The mortality rates were 3 (6.4%), 29 (11.1%), and 31 (18.6%), and the number of patients with rehospitalization was 28 (59.6%), 159 (60.7%), and 124 (74.3%) for the low, intermediate, and high score groups, respectively. Multivariate Cox regression identified H2FPEF score as an independent predictor of all-cause mortality (hazard ratio [HR]: 1.46, 95% CI: 1.23–1.73, P < 0.0001) and rehospitalization (HR: 1.15, 95% CI: 1.08–1.22, P < 0.0001). Receiver operating characteristic (ROC) analysis demonstrated the H2FPEF score can effectively predict all-cause mortality (AUC 0.67, 95% CI: 0.60–0.73, P < 0.0001) and rehospitalization (AUC 0.59, 95% CI: 0.54–0.65, P = 0.001) after adjusting for age and NYHA class. With a cut-off value of 5.5, the sensitivity and specificity were 68.3% and 55.4% for all-cause mortality and 50.5% and 66.7% for rehospitalization.

Conclusions: The H2FPEF score can be used to predict prognosis in HFpEF patients. Higher scores are associated with higher all-cause mortality and rehospitalization.