HFpEF risk assessment using H₂FPEF score in community-dwelling young Hispanic adults

Heart failure with preserved ejection fraction (HFpEF) prevalence has increased with the increase in cardiometabolic risk factors and yet, diagnosis remains underrecognized in the community, with concomitant undertreatment. H₂FPEF scoring is a validated tool for dyspnea evaluation but has potential to identify individuals with increased HFpEF risk in asymptomatic populations. Hispanics are known to have high prevalence of cardiometabolic risk, which predispose them to HFpEF. This study aimed to apply the H₂FPEF score to a community-dwelling Hispanic cohort, and define demographic and clinical covariate associations, particularly in asymptomatic young Hispanic adults.

Demographic, cardiometabolic and echocardiographic data were obtained in 1,285 asymptomatic participants (66% females, mean age 53 ± 15 years) from the Cameron County Hispanic Cohort. H₂FPEF scoring was performed, and the sample divided into low risk (0-2 points) or intermediate-high risk (3-7 points). Analysis was dichotomized to those <60 years and ≥60 years of age, and multivariate logistic regression analyses were conducted.

Intermediate-high risk H₂FPEF score was seen in 43% (n = 555) of the sample. Among those <60 years of age, a third (33%) already had intermediate-high H₂FPEF scores. After adjusting for covariates, among young Hispanics, age [OR=1.02 (1.01-1.04)], metabolic syndrome [OR=2.16 (1.54-3.04)], higher hemoglobin A1c [OR 1.23 (1.08-1.39)] and sedentary lifestyle [OR=0.60 (0.41-0.88)] remained significantly associated with odds of increased H₂FPEF score.

We showed that a large proportion of Hispanics in our cohort have intermediate-high H₂FPEF scores, and this pattern was already seen among young Hispanics. A simple and useful tool such as the H₂FPEF score to identify persons at risk for HFpEF, particularly in communities with limited resources, may be relevant for prevention and early intervention, specifically targeting cardiometabolic risk control in young Hispanics.