HFA-PEFF and H₂FPEF scores for cardiovascular risk stratification in patients with sick sinus syndrome

The HFA-PEFF and H₂FPEF scores were developed to aid in the diagnosis of heart failure with preserved ejection fraction (HFpEF) and have demonstrated prognostic value. Although sick sinus syndrome (SSS) is closely associated with both atrial fibrillation (AF) and HFpEF, the prognostic utility of these scores in patients with SSS remains unknown. This multicenter observational study included 206 patients with SSS and preserved left ventricular ejection fraction who underwent dual-chamber pacemaker implantation. HFA-PEFF and H₂FPEF scores were calculated using baseline clinical and echocardiographic data. The primary endpoint was a composite of heart failure hospitalization, ischemic stroke, and cardiovascular death. The secondary endpoint was persistent AF lasting ≥ 7 days. Over a median follow-up of 36 months, 35 patients experienced the primary endpoint and 45 developed persistent AF. Kaplan-Meier analysis showed that patients with higher HFA-PEFF scores had a significantly increased risk of both the primary endpoint and persistent AF. In multivariable Cox regression analysis, the HFA-PEFF score remained independently associated with the primary endpoint and persistent AF after adjustment for clinically relevant covariates. In contrast, the H₂FPEF score was not independently associated with the primary endpoint. Similar findings were observed when the analysis was restricted to patients without a history of paroxysmal AF. The HFA-PEFF score may be a useful tool for cardiovascular risk stratification and prediction of persistent AF in patients with SSS and preserved ejection fraction after pacemaker implantation.