H₂FPEF Score for Estimating the Probability of Heart Failure with Preserved Ejection Fraction in Persons with Unexplained Dyspnea
The simple, validated H₂FPEF scoring system based on clinical and echocardiographic parameters, developed by experts from the Mayo Clinic, allows the differentiation of heart failure with preserved ejection fraction (HFpEF) from dyspnea of other etiologies and helps decide whether further examinations are necessary. The score can be calculated online and in the Czech language.
HFpEF – A Common but Difficult to Identify Problem
Heart failure with preserved ejection fraction (HFpEF) is common but also a difficult-to-diagnose condition, with few available effective treatment options. It is the most common type of heart failure in older individuals. It develops slowly over years, and a single causative trigger usually cannot be identified.
What Does the H₂FPEF Score Consist Of?
Experts from the Mayo Clinic created and published the H₂FPEF scoring system in 2018, which can estimate the likelihood of HFpEF in patients with unexplained exertional dyspnea.1 The H₂FPEF score can be calculated based on non-invasive examinations, specifically six clinical and echocardiographic parameters. These include body mass index (BMI), age, use of antihypertensive medication, presence of atrial fibrillation, echocardiographic E/e' ratio, and echocardiographic estimation of systolic pulmonary artery pressure.
Two systems have been developed:
- A simple score ranging from 0 to 9 points can be used to stratify patients into categories with low (< 2 points), moderate (2–5 points), or high (≥ 6 points) probability of developing HFpEF. The chances of having HFpEF double with each 1-point increase in the score (odds ratio [OR] 1.98; 95% confidence interval [CI] 1.74–2.30; p < 0.0001).
- A more complex continuous scoring model that does not include the category of antihypertensive medication can be used for a more precise estimation of the likelihood of HFpEF.
... and What Can It Do?
The H₂FPEF score has been externally validated and is recommended in the 2022 AHA/ACC/HFSA heart failure treatment guidelines. For patients with unexplained exertional dyspnea, it helps distinguish HFpEF from dyspnea of non-cardiac causes and determine whether further examinations are necessary.
According to an analysis published in Nature Cardiovascular Research in 2022, this score can identify HFpEF in the preclinical stage.2 In adults without heart failure, an increasing H2FPEF score was associated with greater left atrial dilatation, left ventricular hypertrophy, and more severe diastolic dysfunction. These individuals had higher pulmonary pressures, higher filling pressures, a lower cardiac index, and reduced aerobic capacity during exercise.
A Simple and Practical Tool Available in Czech
The score calculation is available online in Czech.3 Besides the calculation, the website allows printing of the result, sending feedback (suggestions for improvement, reporting problems), provides basic information about the scoring system, the formula for score calculation, and references.
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Sources:
1. Reddy Y. N. V., Carter R. E., Obokata M. et al. A simple, evidence-based approach to help guide diagnosis of heart failure with preserved ejection fraction. Circulation 2018; 138 (9): 861–870, doi: 10.1161/CIRCULATIONAHA.118.034646.
2. Koepp K. E., Reddy Y. N. V., Obokata M. et al. Identification of patients with preclinical heart failure with preserved ejection fraction using the H2FPEF score. Nat Cardiovasc Res 2022 Jan; 1 (1): 59–66, doi: 10.1038/s44161-021-00005-5.
3. H₂FPEF Score. Mediately. Available at: https://mediately.co/cz/tools/H2FPEF
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