H 2 FPEF Score and Charlson Comorbidity Index as Independent Predictors of Cardiovascular Outcomes in Elderly Patients Undergoing Geriatric Rehabilitation

Background Heart failure with preserved ejection fraction (HFpEF) is difficult to diagnose in older adults. The H 2 FPEF score estimates the likelihood of HFpEF and has been associated with adverse prognosis, but its performance has not been evaluated in geriatric inpatients with a high comorbidity burden. Hypothesis We hypothesized that the H 2 FPEF score predicts adverse outcomes in geriatric inpatients independently of comorbidity burden. Methods This prospective cohort included consecutive patients admitted to a geriatric rehabilitation unit. All patients underwent functional and echocardiographic assessment at admission. The ability of the H 2 FPEF score, the Charlson comorbidity index (CCI), and their combination to predict 1‐year all‐cause mortality (ACM) or cardiovascular rehospitalization (CR) was evaluated. Results Among 302 patients (median age 83 years, 40% men), 24% had a H 2 FPEF score ≥ 6 indicating high HFpEF probability and 42% had a CCI > 3 indicating high comorbidity burden. The H 2 FPEF score correlated with CCI ( β = 0.27, p < 0.01) and functional disability (lower Instrumental Activities of Daily Living score; β = −0.17, p = 0.003), but not with cognitive impairment. Both a high H 2 FPEF score and high CCI were associated with a higher risk of the combined outcome of 1‐year ACM or CR (adjusted HR 2.89 [95% CI 1.63–5.10], p < 0.001 and adjusted HR 2.66 [95% CI 1.67–4.21], p < 0.001, respectively), with no interaction between them ( p = 0.63). Patients with both high‐risk scores had the highest risk (adjusted HR 4.66 [95% CI 2.54–8.57], p < 0.001). Conclusions In geriatric inpatients, a high H 2 FPEF score is common and independently identifies patients at increased risk of adverse cardiovascular outcomes at 1 year.