Performance of the HFpEF-ABA, H₂FPEF, and HFA-PEFF Algorithms in Heart Failure With Preserved Ejection Fraction: A...

Several scores have been introduced to improve the diagnosis of heart failure with preserved ejection fraction (HFpEF). Whether these scores enhance risk stratification in established HFpEF remains uncertain.

In this analysis including persons with HFpEF, clinical outcomes according to different HFpEF diagnosis models were explored.

First, clinical outcomes and trial-specific treatment effects were evaluated according to HFpEF-ABA score in a participant-level pooled analysis of 5 clinical trials (CHARM-Preserved, I-PRESERVE, TOPCAT-Americas, PARAGON-HF, and DELIVER). Second, using echocardiography data (TOPCAT-Americas and PARAGON-HF), associations between the HFpEF-ABA, H₂FPEF, and HFA-PEFF models and clinical outcomes were assessed.

Among 15,318 participants, 38% and 62% had a low/intermediate and high HFpEF-ABA score, respectively. Higher HFpEF-ABA scores were incrementally associated with a higher rate of cardiovascular and mortality outcomes. Participants with a high vs low/intermediate HFpEF-ABA score experienced a 75% higher rate of cardiovascular death or HF hospitalization (hazard ratio [HR], 1.75; 95% CI, 1.62-1.89; P < .001). However, risk discrimination was limited (C statistic, 0.559; 95% CI, 0.550-0.567). Trial-specific treatment effects appeared consistent irrespective of HFpEF-ABA score. Among echocardiography substudy participants (n = 1300), only the H₂FPEF (HR per unit increase, 1.06; 95% CI, 1.00-1.11) and HFA-PEFF (HR per unit increase, 1.10; 95% CI, 1.03-1.19) models were statistically significantly associated with cardiovascular death or HF hospitalization; risk discrimination was modest for all models (C statistic range, 0.524-0.529).

While risk scores developed to improve HFpEF diagnosis were associated with adverse outcomes in this pooled trial analysis, their utility for risk stratification once HFpEF is established appears modest.