Clinical Prognostic Scoring Systems in Heart Failure with Preserved Ejection Fraction: An Integrative Review of Risk...

Area of Science:

• Cardiology
• Clinical Medicine
• Health Services Research

Background:

• Risk stratification in heart failure with preserved ejection fraction (HFpEF) is inconsistent in clinical practice.
• Existing prognostic scores face challenges in routine application and interpretation.
• Controversies include the use of broad clinical scores versus pathophysiology-based tools and static versus dynamic risk assessment.

Purpose of the Study:

• To conduct a narrative synthesis of clinician-usable prognostic instruments for HFpEF.
• To compare these tools across different conceptual domains and care settings.
• To emphasize feasibility and clinical interpretability for practical application.

Main Methods:

• Performed a narrative, comparative synthesis of prognostic instruments in HFpEF.
• Extracted study context, endpoints, follow-up, and performance metrics.
• Focused on instruments that are feasible and clinically interpretable.

Main Results:

• Baseline clinical instruments show moderate discrimination; tools reflecting congestion and physiological changes perform better.
• Discharge lung ultrasound B-lines predict early post-discharge events.
• Immuno-nutritional indices and serial reassessments offer complementary prognostic insights, with patient-reported health adding value.

Conclusions:

• A layered, phenotype-aware strategy is optimal for HFpEF prognostication.
• This approach integrates global clinical risk, biomarkers, discharge congestion assessment, and serial reassessment.
• Relying on a single score is less effective than a comprehensive, dynamic strategy.