Applying the ESC 2016, H2FPEF, and HFA-PEFF Diagnostic Algorithms for Heart Failure with Preserved Ejection Fraction to the General Population

Figures

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  Figure 1. PRISMA study. From a total of 8245 subjects providing a transthoracic echocardiography examination, 1724 were excluded because of left ventricular ejection fraction (LVEF) <50%, more than mild left‐sided valve stenosis, more than moderate valve regurgitation, or missing variables. Further, 908 subjects were excluded because of non‐cardiac causes of dyspnoea. Consequently, 5613 subjects were included in the study analysis. Of those, 407 subjects suffered from unexplained dyspnoea or self‐reported heart failure. First, the prevalence of heart failure with preserved ejection fraction applying the European Society of Cardiology 2016, H2FPEF, and HFA‐PEFF algorithms was calculated. Second, the inter‐score concordance was assessed using Cohen's kappa coefficient. COPD, chronic obstructive pulmonary disease.

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  Figure 2. Prevalence of heart failure with preserved ejection fraction (HFpEF) according to the European Society of Cardiology (ESC) 2016 algorithm and the H2FPEF and HFA‐PEFF scores in subjects with unexplained dyspnoea. According to the ESC 2016 algorithm, 20.4% were diagnosed with HFpEF, the H2FPEF HFpEF group included 12.3%, and 7.6% were in the HFA‐PEFF HFpEF group; 59.2% and 57.5% were classified as ‘HFpEF not excludable’ according to the H2FPEF and HFA‐PEFF scores.

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  Figure 3. Prevalence and concordance of the three heart failure with preserved ejection fraction algorithms in subjects with unexplained dyspnoea. Of the 407 subjects with unexplained dyspnoea or self‐reported heart failure, the prevalence ranged from 20.4% [n = 83, European Society of Cardiology (ESC) 2016 guideline] to 12.3% (n = 50, H2FPEF score) and 7.6% (n = 31, HFA‐PEFF score). The concordance was highest between the ESC 2016 guidelines and the HFA‐PEFF score reflected by a kappa coefficient of 0.38 and a reclassification rate (RecR) of 16%.