Key result
Adding dynamic assessments like lung ultrasound improves risk discrimination of baseline prognostic scores in HFpEF.
A layered, phenotype-aware strategy integrating clinical risk scores, biomarkers, congestion assessment, and serial reassessment is recommended for optimal HFpEF prognostication.
INTRODUCTION: Risk stratification in heart failure with preserved ejection fraction (HFpEF) remains inconsistent in routine care despite multiple prognostic scores. Key controversies persist. One concerns broad, clinically derived scores versus pathophysiology-grounded tools, including diagnostic frameworks used pragmatically for prognostication. Another concern is the distinction between static baseline risk and dynamic risk states that change across hospitalization and follow-up. METHODS: We performed a narrative, comparative synthesis of clinician-usable prognostic instruments in HFpEF across conceptual domains and care settings. We extracted study context, endpoints, follow-up, and performance metrics. We emphasized feasibility and clinical interpretability. RESULTS: Across studies, discrimination of baseline-only clinical instruments is generally moderate. Performance is often higher for tools that reflect congestion and physiological changes, particularly when reassessed at clinically meaningful time points. Discharge lung ultrasound B-lines, reflecting residual pulmonary congestion, frequently predict early post-discharge events. Immuno-nutritional indices derived from routine laboratory tests provide a complementary prognostic signal, especially in older or recently hospitalized patients. Serial trajectories appear more informative than single measurements. Patient-reported health adds independent prognostic information and supports risk communication. Diagnostic frameworks can stratify risk when constituent data are available, and phenotype distributions are compatible, but transportability and calibration remain recurrent limitations. CONCLUSION: HFpEF prognostication is best supported by a layered, phenotype-aware strategy. This approach integrates global clinical risk, selected biomarkers, discharge congestion assessment, and serial reassessment, rather than relying on a single score.
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Draghici et al. (2026) conducted a review in Heart failure with preserved ejection fraction (HFpEF). Clinical prognostic scoring systems was evaluated on Prognostic performance (discrimination, calibration) for mortality and heart failure hospitalization. Baseline clinical prognostic scores in HFpEF offer moderate discrimination, which improves when integrating dynamic assessments such as discharge lung ultrasound B-lines and serial immuno-nutritional indices.
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