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Comparing diagnostic tools for heart failure with preserved ejection fraction across community and clinical cohorts

Monzo, Luca ; Huttin, Olivier ; Bozkurt, Biykem ; Duarte, Kévin ; Linde, Cecilia ; Lund, Lars H ; Hage, Camilla ; Donal, Erwan ; Magnusson, Martin LU orcid and Nilsson, Peter LU , et al. (2025) In Heart
Abstract

BACKGROUND: Diagnosing heart failure with preserved ejection fraction (HFpEF) remains challenging, particularly in older adults. While the Heart Failure Association (HFA)-PEFF and H2FPEF Scores offer structured diagnostic approaches, their clinical utility is still debated. This study aims to compare the diagnostic accuracy of HFpEF Scores versus inclusion criteria used in sodium-glucose cotransporter-2 inhibitors (SGLT2i) trials, age-adjusted N-terminal pro B-type natriuretic peptide (NT-proBNP) thresholds and the universal definition of heart failure (HF).

METHODS: Diagnostic tools were assessed using sex-weighted and age-weighted propensity score adjustment in individuals aged 60-80 years from two established HFpEF cohorts... (More)

BACKGROUND: Diagnosing heart failure with preserved ejection fraction (HFpEF) remains challenging, particularly in older adults. While the Heart Failure Association (HFA)-PEFF and H2FPEF Scores offer structured diagnostic approaches, their clinical utility is still debated. This study aims to compare the diagnostic accuracy of HFpEF Scores versus inclusion criteria used in sodium-glucose cotransporter-2 inhibitors (SGLT2i) trials, age-adjusted N-terminal pro B-type natriuretic peptide (NT-proBNP) thresholds and the universal definition of heart failure (HF).

METHODS: Diagnostic tools were assessed using sex-weighted and age-weighted propensity score adjustment in individuals aged 60-80 years from two established HFpEF cohorts (MEtabolic Road to DIAstolic Heart Failure (MEDIA), n=297; Karolinska-Rennes (KaRen), n=174) and two community-based cohorts without HF (Suivi Temporaire Annuel Non-Invasif de la Santé des Lorrains Assurés Sociaux (STANISLAS), n=461; Malmö, n=1030).

RESULTS: HFA-PEFF and H2FPEF Scores classified a large proportion of participants in both community-based cohorts (up to 81% in Malmö) and HFpEF cohorts (up to 75% in MEDIA) in the intermediate-likelihood category, requiring further diagnostic evaluation. Their diagnostic discrimination ranged from moderate to good. The universal definition of HF, SGLT2i trial criteria and NT-proBNP age-adjusted thresholds showed diagnostic performance comparable to HFA-PEFF Scores in the HFpEF cohorts and correctly excluded almost all individuals in the community cohorts. The universal definition of HF demonstrated a diagnostic discrimination higher than H2FPEF and comparable to HFA-PEFF, with the most balanced performance in terms of sensitivity and specificity.

CONCLUSIONS: Using scores, a substantial proportion of HFpEF individuals fall into the intermediate likelihood category, highlighting diagnostic uncertainty. Simpler tools, such as the universal definition of HF, demonstrate comparable or even superior diagnostic and rule-out performances for HFpEF, emphasising the need for more practical and reliable approaches to HFpEF diagnosis.

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Contribution to journal
publication status
epub
subject
in
Heart
publisher
BMJ Publishing Group
external identifiers
  • pmid:41249034
  • scopus:105022080238
ISSN
1355-6037
DOI
10.1136/heartjnl-2025-326517
language
English
LU publication?
yes
additional info
© Author(s) (or their employer(s)) 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.
id
1fa2ea4b-3e1d-46e0-a776-18d091346ad1
date added to LUP
2025-11-18 11:16:13
date last changed
2026-03-11 12:54:58
@article{1fa2ea4b-3e1d-46e0-a776-18d091346ad1,
  abstract     = {{<p>BACKGROUND: Diagnosing heart failure with preserved ejection fraction (HFpEF) remains challenging, particularly in older adults. While the Heart Failure Association (HFA)-PEFF and H2FPEF Scores offer structured diagnostic approaches, their clinical utility is still debated. This study aims to compare the diagnostic accuracy of HFpEF Scores versus inclusion criteria used in sodium-glucose cotransporter-2 inhibitors (SGLT2i) trials, age-adjusted N-terminal pro B-type natriuretic peptide (NT-proBNP) thresholds and the universal definition of heart failure (HF).</p><p>METHODS: Diagnostic tools were assessed using sex-weighted and age-weighted propensity score adjustment in individuals aged 60-80 years from two established HFpEF cohorts (MEtabolic Road to DIAstolic Heart Failure (MEDIA), n=297; Karolinska-Rennes (KaRen), n=174) and two community-based cohorts without HF (Suivi Temporaire Annuel Non-Invasif de la Santé des Lorrains Assurés Sociaux (STANISLAS), n=461; Malmö, n=1030).</p><p>RESULTS: HFA-PEFF and H2FPEF Scores classified a large proportion of participants in both community-based cohorts (up to 81% in Malmö) and HFpEF cohorts (up to 75% in MEDIA) in the intermediate-likelihood category, requiring further diagnostic evaluation. Their diagnostic discrimination ranged from moderate to good. The universal definition of HF, SGLT2i trial criteria and NT-proBNP age-adjusted thresholds showed diagnostic performance comparable to HFA-PEFF Scores in the HFpEF cohorts and correctly excluded almost all individuals in the community cohorts. The universal definition of HF demonstrated a diagnostic discrimination higher than H2FPEF and comparable to HFA-PEFF, with the most balanced performance in terms of sensitivity and specificity.</p><p>CONCLUSIONS: Using scores, a substantial proportion of HFpEF individuals fall into the intermediate likelihood category, highlighting diagnostic uncertainty. Simpler tools, such as the universal definition of HF, demonstrate comparable or even superior diagnostic and rule-out performances for HFpEF, emphasising the need for more practical and reliable approaches to HFpEF diagnosis.</p>}},
  author       = {{Monzo, Luca and Huttin, Olivier and Bozkurt, Biykem and Duarte, Kévin and Linde, Cecilia and Lund, Lars H and Hage, Camilla and Donal, Erwan and Magnusson, Martin and Nilsson, Peter and Leosdottir, Margret and Bozec, Erwan and Baudry, Guillaume and Zannad, Faiez and Girerd, Nicolas}},
  issn         = {{1355-6037}},
  language     = {{eng}},
  month        = {{11}},
  publisher    = {{BMJ Publishing Group}},
  series       = {{Heart}},
  title        = {{Comparing diagnostic tools for heart failure with preserved ejection fraction across community and clinical cohorts}},
  url          = {{http://dx.doi.org/10.1136/heartjnl-2025-326517}},
  doi          = {{10.1136/heartjnl-2025-326517}},
  year         = {{2025}},
}