Diving Into the Diagnostic Score Algorithms of Heart Failure With Preserved Ejection Fraction

Due to an aging population, heart failure with preserved ejection fraction (HFpEF) is on the rise. Yet this condition remains difficult to characterize and diagnose. There have been two recently proposed risk scores for the evaluation and diagnosis of patients with suspectedHFpEF (1, 2). These include the European Society of Cardiology (ESC) consensus recommendation for the diagnosis of HFpEF (HFA-PEFF score) (1) and the H2FPEF (2) score. The H2FPEF score was developed from evaluation of patients with dyspnea and identified that obesity, hypertension, atrial fibrillation, pulmonary hypertension, older age (>60 years old), and evidence of elevated filling pressures on echocardiogram were associated with invasively confirmed elevation of filling pressures used as the gold standard for the HFpEF diagnosis. The HFA-PEFF score from the ESC is based on expert consensus and refers to a multi-step evaluation process of patients with dyspnea to diagnose HFpEF. The scoring systems aim to replace current simpler and phenomenological American College of Cardiology/American Heart Association definitions of HFpEF, which relies on signs and symptoms of heart failure, evidence of abnormal diastolic parameters, and preserved ejection fraction. This opinion piece offers concerns over attempts to protocolize a vastly heterogenous group of patients using diagnostic scoring systems.