H2FPEF Score: Clinical Significance and Calculation

Introduction to H2FPEF Score

The American College of Cardiology recommends using the H2FPEF score, a validated 0-9 point diagnostic tool, to diagnose Heart Failure with preserved Ejection Fraction (HFpEF), with scores ≥6 indicating high likelihood of HFpEF, scores <2 indicating low likelihood, and scores 2-5 requiring further hemodynamic testing to confirm the diagnosis 1, 2, 3

The H2FPEF score integrates six weighted variables, including obesity, hypertension, atrial fibrillation, pulmonary hypertension, age, and filling pressure, to create a composite score ranging from 0 to 9 1, 2, 3, 4, 5
The components and point values of the H2FPEF score are:

The H2FPEF score demonstrates excellent discrimination with a c-statistic of 0.841 (95% CI: 1.74-2.30; P<0.0001) and doubles the odds of HFpEF for each 1-unit score increase (odds ratio 1.98) 1, 2, 3
The American College of Cardiology suggests that a low H2FPEF score should not exclude HFpEF diagnosis when clinical suspicion is high based on symptoms, signs, and elevated natriuretic peptides 6

The H2FPEF score can be used for risk stratification, with scores <2 indicating low likelihood of HFpEF, scores 2-5 indicating intermediate likelihood, and scores ≥6 indicating high likelihood of HFpEF 1, 2, 3, 4, 5
For patients with intermediate likelihood (2-5 points), further evaluation is required with exercise echocardiogram or cardiac catheterization to confirm or exclude HFpEF 1, 2, 3, 4, 5

The American College of Cardiology recommends using the H2FPEF score in clinical practice to guide diagnosis and treatment of HFpEF, with consideration of additional factors such as chronic kidney disease and diabetes 6, 7
Many clinicians may reasonably initiate a therapeutic trial of guideline-directed medical therapy (diuretics plus SGLT2 inhibitor) and assess for symptomatic improvement rather than pursuing invasive testing for patients with intermediate scores 6