Key result
Higher HFA-PEFF score linked to ~39% greater risk of all-cause death in HFpEF.
Why the study?
To comprehensively assess the diagnostic and prognostic performances of the HFA-PEFF score for HFpEF.
Does the HFA-PEFF score accurately diagnose HFpEF and predict cardiovascular events and all-cause death in patients with suspected or confirmed HFpEF?
Meta-Analysis (n=6,420)
Does the HFA-PEFF score accurately diagnose HFpEF and predict cardiovascular events and all-cause death in patients with suspected or confirmed HFpEF?
The HFA-PEFF score is a valid and useful clinical tool for both the diagnosis of HFpEF and the prediction of all-cause mortality in this patient population.
Answers are grounded in this paper and cite their sources.
Supports HFA-PEFF integration into HFpEF risk stratification; reinforces its prognostic value beyond diagnosis.
Aim To assess the diagnostic and prognostic performances of the Heart Failure Association Pre-test Assessment, Echocardiography & Natriuretic Peptide, Functional Testing, Final Etiology (HFA-PEFF) score for heart failure with preserved ejection fraction (HFpEF) in a comprehensive manner. Methods PubMed, Embase, Cochrane Library, and Web of Science were comprehensively searched from the inception to June 12, 2023. Studies using the “Rule-out” or “Rule-in” approach for diagnosis analysis or studies on cardiovascular events and all-cause death for prognosis analysis were included. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS−2) tool was adopted to assess the quality of diagnostic accuracy studies. The sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the summary receiver operating characteristic (SROC) curve (AUC) were presented with 95% confidence intervals (CIs). For CVEs and all-cause death, the hazard ratio (HR) values were calculated. Results Fifteen studies involving 6420 subjects were included, with 9 for diagnosis analysis, and 7 for prognosis analysis. For the diagnostic performance of the HFA-PEFF score, with the “Rule-out” approach, the pooled SEN was 0.96 (95%CI: 0.94, 0.97), the pooled SPE was 0.39 (95%CI: 0.37, 0.42), and the pooled AUC was 0.85 (95%CI: 0.67, 1.00), and with the “Rule-in” approach, the pooled SEN was 0.59 (95%CI: 0.56, 0.61), the pooled SPE was 0.86 (95%CI: 0.84, 0.88), and the pooled AUC was 0.83 (95%CI: 0.79, 0.87). For the predictive performance of the HFA-PEFF score, regarding CVEs, the pooled SEN was 0.63 (95%CI: 0.58, 0.67), the pooled SPE was 0.53 (95%CI: 0.49, 0.58), and the pooled AUC was 0.65 (95%CI: 0.40, 0.90), and concerning All-cause death, the pooled SEN was 0.85 (95%CI: 0.81, 0.88), the pooled SPE was 0.48 (95%CI: 0.44, 0.52), and the pooled AUC was 0.65 (95%CI: 0.47, 0.83). A higher HFA-PEFF score was associated with a higher risk of all-cause death (HR 1.390, 95%CI 1.240, 1.558, P < 0.001). Conclusion The HFA-PEFF score might be applied in HFpEF diagnosis and all-cause death prediction. More studies are required for finding validation.
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Li et al. (2024) conducted a meta-analysis in Heart failure with preserved ejection fraction (HFpEF) (n=6,420). HFA-PEFF score was evaluated on All-cause death (HR 1.390, 95% CI 1.240-1.558, p=<0.001). A higher HFA-PEFF score was associated with an increased risk of all-cause death in patients with heart failure with preserved ejection fraction.
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