Key result
The prevalence of confirmed HFpEF varied significantly depending on the diagnostic algorithm applied, ranging from 28.5% (2021 ESC guideline) to 21.1% (HFA-PEFF) and 4.7% (H2FPEF), with only 3.5% overlap across all three.
Why the study?
What is the prevalence and diagnostic concordance of HFpEF using the 2021 ESC HF guideline, HFA-PEFF score, and H2FPEF score in patients with unexplained dyspnea?
Observational (n=992)
No
What is the prevalence and diagnostic concordance of HFpEF using the 2021 ESC HF guideline, HFA-PEFF score, and H2FPEF score in patients with unexplained dyspnea?
The diagnosis of HFpEF in patients with unexplained dyspnea varies significantly depending on whether the 2021 ESC guideline, HFA-PEFF, or H2FPEF score is used, highlighting the need for a unified diagnostic consensus.
The HFA-PEFF and H 2 FPEF scores were recently proposed to help diagnose heart failure (HF) with preserved ejection fraction (HFpEF). We aimed to evaluate HFpEF prevalence according to the 2021 European Society of Cardiology (ESC) HF guideline and the HFA-PEFF and H 2 FPEF scores in patients with unexplained dyspnea and to compare the concordance between these three algorithms in diagnosing HFpEF. We analyzed 992 patients with unexplained dyspnea suspected of having HFpEF, who underwent echocardiography, cardiopulmonary exercise testing, and N-terminal pro-brain natriuretic peptide measurement at a single tertiary center. Patients were classified as having confirmed, suspected, or no HFpEF on high, intermediate, or low scores according to HFA-PEFF or H 2 FPEF. Additionally, patients were classified into three categories according to elevated natriuretic peptide levels and echocardiographic parameters following the 2021 ESC HF guideline. Among the 992 patients included, confirmed prevalence HFpEF ranged from 28.5% (2021 ESC) to 21.1% (HFA-PEFF) and 4.7% (H 2 FPEF). Significant differences in the prevalence of hypertension, atrial fibrillation, number of antihypertensive medications, natriuretic peptide levels, and echocardiographic parameters of diastolic dysfunction were observed among the three HFpEF groups, with the highest burden in the group defined by the H 2 FPEF score. Comparing the HFA-PEFF and H 2 FPEF scores, 40.2% of patients were classified into different likelihood categories for HFpEF depending on the score used. The overlap of patients diagnosed with confirmed HFpEF according to the three algorithms was limited to 3.5%. HFpEF prevalence in patients with unexplained dyspnea varied significantly depending on the algorithm applied.
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Yoon et al. (2025) conducted an observational in Unexplained dyspnea suspected of having HFpEF (n=992). Diagnostic algorithms (2021 ESC guideline, HFA-PEFF, and H2FPEF scores) vs. Cross-comparison between algorithms was evaluated on Prevalence of confirmed HFpEF and diagnostic concordance. The prevalence of confirmed HFpEF varied significantly depending on the diagnostic algorithm applied, ranging from 28.5% (2021 ESC guideline) to 21.1% (HFA-PEFF) and 4.7% (H2FPEF), with only 3.5% overlap across all three.
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