H2FPEF score

H2FPEF score

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 [1]. 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

P Pulmonary 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 [1].

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 [2]. 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 [3]. 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.


  1. Reddy YNV, Carter RE, Obokata M, Redfield MM, Borlaug BA. A Simple, Evidence-Based Approach to Help Guide Diagnosis of Heart Failure With Preserved Ejection Fraction. Circulation. 2018 Aug 28;138(9):861-870.
  2. Suzuki S, Kaikita K, Yamamoto E, Sueta D, Yamamoto M, Ishii M, Ito M, Fujisue K, Kanazawa H, Araki S, Arima Y, Takashio S, Usuku H, Nakamura T, Sakamoto K, Izumiya Y, Soejima H, Kawano H, Jinnouchi H, Matsui K, Tsujita K. H2 FPEF score for predicting future heart failure in stable outpatients with cardiovascular risk factors. ESC Heart Fail. 2020 Feb;7(1):65-74. 
  3. Tao Y, Wang W, Zhu J, You T, Li Y, Zhou X. H2FPEF score predicts 1-year rehospitalisation of patients with heart failure with preserved ejection fraction. Postgrad Med J. 2021 Mar;97(1145):164-167.