The HFpEF-ABA score predicts adverse cardiac remodelling and incident heart failure: a UK biobank study

INTRODUCTION: The HFpEF-ABA score (age, body mass index, atrial fibrillation) was originally derived to diagnose heart failure with preserved ejection fraction (HFpEF) in symptomatic patients. However, its utility as a preventive screening tool to identify preclinical risk in unselected community populations remains unvalidated.To validate the HFpEF-ABA score in a large community-based cohort free of heart failure and structural heart disease, utilizing a dual validation approach combining cardiac magnetic resonance phenotyping and long-term outcome prediction. METHODS: We analysed 416 374 UK Biobank participants without baseline heart failure. Participants were stratified by HFpEF-ABA score into low, intermediate, and high risk. We assessed biological validity in a subcohort of 65 293 participants utilizing cardiac magnetic resonance, and clinical validity via prospective adjudication of heart failure hospitalization over a median follow-up of 14.9 years. RESULTS: Structurally, elevated scores identified characteristic patterns of adverse cardiac remodelling in individuals at high risk for incident heart failure despite the absence of a clinical diagnosis: high-risk individuals exhibited profound left atrial dysfunction (LA ejection fraction 55.48% vs. 61.92%, P < .001) and distinct concentric ventricular remodelling compared with low-risk participants. Clinically, this structural substrate translated into a 6.4-fold excess risk of incident heart failure hospitalization (hazard ratio HR 6.44, 95% confidence interval CI 5.86-7.08, P < .001) and a 3.5-fold increased risk of the composite outcome (P < .001). The score demonstrated robust discrimination, outperforming its individual components. CONCLUSION: The HFpEF-ABA score demonstrates significant prognostic value for identifying individuals at high risk for incident heart failure and is associated with adverse cardiac remodelling and subclinical cardiac changes. These findings support repositioning the score from a diagnostic aid to a population-level screening instrument, supporting earlier identification of high-risk individuals before overt clinical heart failure develops.