Prognostic Performance of the BREATH 2 Score in Patients With Suspected Heart Failure With Preserved Ejection Fraction

Background and Objectives The BREATH 2 score is a novel screening tool for heart failure with preserved ejection fraction (HFpEF), yet its prognostic value among patients with undiagnosed dyspnea remains unknown. This study aimed to evaluate the association between the BREATH 2 score and clinical outcomes in patients with suspected HFpEF. Methods A total of 700 consecutive patients who underwent exercise stress echocardiography were included. The BREATH 2 score was calculated from seven clinical variables without using echocardiography and then participants were divided into low (0–3), intermediate (4–5), and high-score (6–9) groups. The primary endpoint was a composite of all-cause mortality and heart failure (HF) events (HF hospitalization, unplanned hospital visits requiring intravenous diuretics, or intensification of oral diuretics). Results Over a median follow-up period of 776 days, the primary composite outcome was observed in 127 (18.1%) out of 700 patients with dyspnea. Higher BREATH 2 scores were associated with an increased rate of the composite outcome (log-rank p<0.001). This association remained significant in models including clinical, standard echocardiography or exercise stress echocardiography. Time-dependent receiver operating characteristic curve analysis showed superior prognostic performance of the BREATH 2 score to the H 2 FPEF score (area under the curve [AUC]=0.71 vs. 0.64; p=0.03) and the HFpEF-ABA score (AUC=0.63; p=0.01). Conclusions The BREATH 2 score provides prognostic information among dyspneic patients and may be suitable for primary care settings.