How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic algorithm: a consensus...

Area of Science:

• Cardiology
• Heart Failure Research
• Diagnostic Algorithms

Background:

• Diagnosing chronic heart failure with preserved ejection fraction (HFpEF) presents significant clinical challenges.
• Existing diagnostic methods often lack a standardized, stepwise approach, leading to uncertainty.

Purpose of the Study:

• To introduce and validate the HFA-PEFF diagnostic algorithm, a novel stepwise process for diagnosing HFpEF.
• To provide a structured framework for clinicians to systematically evaluate patients suspected of having HFpEF.

Main Methods:

• The HFA-PEFF algorithm involves four steps: Pre-test assessment (P), Echocardiography and Natriuretic Peptide Score (E), Functional testing (F1), and Final aetiology assessment (F2).
• Step 1 includes clinical evaluation, risk factors, and basic tests. Step 2 utilizes comprehensive echocardiography and natriuretic peptide levels with a scoring system.
• Step 3 involves functional testing (echocardiographic or invasive stress tests) for intermediate scores, and Step 4 focuses on determining the specific cause or alternative diagnoses.

Main Results:

• The algorithm provides a scoring system (≥5 points for definite HFpEF, ≤1 for unlikely HFpEF, 2-4 for uncertainty requiring further testing).
• Elevated natriuretic peptides support HFpEF, but normal levels do not exclude it.
• The stepwise approach aims to clarify diagnoses in challenging HFpEF cases.

Conclusions:

• The HFA-PEFF diagnostic algorithm offers a structured, stepwise approach to improve the diagnosis of HFpEF.
• Further research is needed to refine HFpEF classification and management strategies.
• This algorithm can aid clinicians in differentiating HFpEF from other causes of dyspnea.