Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5

Distribution and utility of HFA-PEFF and H2FPEF scores in the community: Findings from the population-based STAAB cohort

J. Albert1, C. Morbach1, F. Sahiti1, V. Cejka1, N. Moser1, M. Kohls2, F. Eichner2, G. Gelbrich2, P. U. Heuschmann2, S. Störk1, für die Studiengruppe: STAAB

1Deutsches Zentrum für Herzinsuffizienz, Universitätsklinikum Würzburg, Würzburg; 2Institut für Klinische Epidemiologie und Biometrie, Universitätsklinikum Würzburg, Würzburg;

Introduction & Aim: The HFA-PEFF and the H2FPEF scores were developed to assess the probability for heart failure with preserved ejection fraction (HFpEF) in patients with signs and symptoms potentially indicative of heart failure (HF). The utility of these scores in asymptomatic subjects is unknown. We applied both scores to a population-based cohort of individuals aged 30-79 years. We here describe the characteristics of individuals depending on the risk attributed by the respective score and their associated 4-year risk to develop incident HF. Method & Results: We report data of the prospective Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB) cohort study investigating a representative sample of residents of the City of Würzburg, Germany, aged 30 to 79 years, and without history of HF: n=2394, 54±12 years, 52% women, left ventricular ejection fraction ≥50%. For each participant the HFA-PEFF and H2FPEF scores were calculated. The HFA-PEFF score assigns individuals to a score of 0-6 based on structural and functional echocardiographic parameters of diastolic function and natriuretic peptides [Pieske, EJHF 2020]. In contrast the H2FPEF score, ranging from 0-9, is based on clinical characteristics in addition to echocardiographic parameters of diastolic function [Reddy, Circ. 2018]. The following thresholds per score category were applied: low risk (score 0-1), intermediate risk (HFA-PEFF 2-4; H2FPEF 2-5); high risk (HFA-PEFF ≥5; H2FPEF ≥6). Any incident diagnosis of HF during a median follow-up time of 4 years was counted for the primary outcome. Median (quartiles) HFA-PEFF and H2FPEF scores were 1 (0; 2), with respectively 51%/ 68% participants at low risk, 46%/ 32% at intermediate risk, and 3%/ 0.5% at high risk. Among subjects with dyspnea on exertion, the frequency of HFA-PEFF/ H2FPEF risk categories was 39%/ 50% for low risk, 57%/ 49% for intermediate risk, and 4%/ 1% for high risk (Figure). 29% of participants were considered at low risk in both scores, while overlap for the intermediate and high risk groups was 36% and 0.4%, respectively. Remarkably, among participants without dyspnea, 41%/ 25% had an intermediate, and 3%/ 0.2% a high risk according to the respective score. HFA-PEFF score was correlated with higher age (Spearman rho 0.61), higher body mass index (rho 0.26) and lower glomerular filtration rate (GFR, rho -0.32; all p<0.01), as well as higher NT-proBNP levels (rho 0.48). The H2FPEF score was also associated with lower GFR (rho -0.32) and higher NT-proBNP (rho 0.30; both p<0.001). Compared to subjects with low risk, participants with intermediate or high risk had higher prevalence of risk factors such as diabetes mellitus, arteriosclerotic disease and metabolic syndrome (both scores, all p<0.001). Additionally, intermediate/high risk by the HFA-PEFF score was also associated with arterial hypertension and male sex (both p<0.001). Incident HF was diagnosed in 20 participants, of which 80%/75% had an elevated risk according to the HFA-PEFF/H2FPEF algorithm. Conclusion: In a population-based sample free of HF at baseline, across a broad age range, the HFA-PEFF and H2FPEF scores identified participants at increased risk developing HF within a 4-year period. Although diagnostic accuracy appeared promising, future research should refine both scores to enhance their diagnostic accuracy and enable their use in intervention studies.

https://dgk.org/kongress_programme/jt2022/aP1151.html