H2FPEF score is a simple scoring system using clinical characteristics and echocardiography for differentiation of heart failure with preserved ejection fraction (HFpEF) from noncardiac causes of dyspnea . H2FPEF score was developed by Reddy YNV et al using a derivation cohort of 414 consecutive patients comprising of 267 cases with HFpEF and 147 controls. The test cohort included 100 consecutive patients of which 61 had HFpEF. It was a retrospective study in consecutive patients with unexplained dyspnea referred for invasive hemodynamic exercise testing.
The variables used and their weighted scores were as follows:
H2 Heavy: Body mass index > 30 Kg/m2: 2 points
Hypertensive: 2 or more antihypertensive medications: 1 point
F Atrial Fibrillation: Paroxysmal or Persistent: 3 points
PPulmonary hypertension: Pulmonary artery systolic pressure estimated by Doppler echocardiography > 35 mm Hg: 1 point
E Elder: Age > 60 years: 1 point
F Filling Pressure: Doppler Echocardiographic E/e’ > 9: 1 point
Total score possible would range from 0 – 9 points. The odds of HFpEF doubled for each 1 unit increase in H2FPEF score.
The authors suggested that low H2FPEF scores of 0 or 1 can be used to effectively rule out the disease, while scores of 6-9 can be used to make a diagnosis of HFpEF with good confidence. Intermediate scores of 2-5 would call for additional testing .
Suzuki S et al did an external validation of the H2FPEF score in a prospective Japanese cohort of 356 patients with mean age of 73.2 years . Mean H2FPEF score of the entire cohort was 3.1 ± 1.8. Fifteen patients developed heart failure related events during follow up, of which 2 were deaths and 13 were hospitalization for heart failure decompensation. H2FPEF score was significantly associated with the future occurrence of heart failure related events (P < 0.001). A score of 7 points out of 9 had a sensitivity of 47% and specificity of 96%. The study was in stable Japanese outpatients with at least one cardiovascular risk factor.
Another study by Tao Y et al evaluated 151 patients with HFpEF in a prospective cohort to check the association between H2FPEF score and one year readmission for heart failure . They found that H2FPEF score had excellent predictive value for one year rehospitalization in HFpEF patients. They further observed that obesity, age >70 years, treatment with ≥2 antihypertensives, echocardiographic E/e’ ratio >9 and pulmonary artery pressure >35 mm Hg were independent predictors of one year readmission.