Screening for heart failure with preserved ejection fraction using the BREATH₂ score: diagnostic performance and...

Heart failure with preserved ejection fraction (HFpEF) is more prevalent in aging societies and remains challenging to diagnose in primary care. The BREATH₂ score is a screening tool for diagnosing HFpEF in Japanese primary care settings. However, its broader utility and association with cardiac outcomes are unclear.

This study aimed to evaluate the diagnostic utility of the BREATH₂ score for HFpEF and its prognostic value for cardiac event.

This retrospective, single-center study examined 234 patients (median age 73 years; 25.6% female) with a left ventricular ejection fraction ≥ 50%. HFpEF was diagnosed using the HFA-PEFF algorithm. The BREATH₂ scores were categorized as low (≤ 3), intermediate (4-5), or high (≥ 6) risk. Defined cardiac event was either cardiac death or HF hospitalization.

HFpEF prevalence rose progressively with the BREATH₂ score, with 10.5% of participants in the low-, 38.6% in the intermediate-, and 70.3% in the high-risk groups. The BREATH₂ score discriminated HFpEF from non-HFpEF better than the H₂FPEF score (AUC 0.81 vs. 0.69, P < 0.001). During the median follow-up period of 287 days, 17 (7.3%) patients experienced first cardiac event. Each 1-point increase in the BREATH₂ score was associated with increased risk of a cardiac event (Hazard ratio 1.94, P < 0.001), independent of H₂FPEF or HFA-PEFF scores. Kaplan-Meier analysis demonstrated increasing cardiac event as the BREATH₂ score increased.

The BREATH₂ score was associated with HFpEF and more cardiac event, suggesting possible utility as a screening tool in primary care.