The <scp>HFA‐PEFF</scp> and <scp>H<sub>2</sub>FPEF</scp> scores largely disagree in classifying patients with suspected heart failure with preserved ejection fraction

Wijk, Sandra Sanders‐van; Aizpurua, Arantxa Barandiarán; Rocca, Hans‐Peter Brunner‐La; Henkens, Michiel T.H.M.; Weerts, Jerremy; Knackstedt, Christian; Uszko-Lencer, Nicole H.M.K.; Heymans, Stéphane; Empel, Vanessa van

doi:10.1002/ejhf.2019

Cited by 48 publications

(33 citation statements)

References 6 publications

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“…These scores, however, are not without controversy, with criticisms ranging from over-simplification of the diagnostic challenges to over-complicating the diagnostic process by requiring expensive tests or the scores largely disagree. 35 , 36 In addition, misclassification has been reported, especially in those patients with low HFpEF scores, potentially due to the fact that both scores use resting parameters in a phenotype in which physiological abnormalities augment during exercise. 33 , 37 Nevertheless, both scores have been shown to have prognostic utility in human patients, 38 , 39 suggesting that they capture key pathophysiologic components that determine outcomes in HFpEF.…”

Section: Hfpef: a Heterogeneous Disease With Multiple Disease Mechanismsmentioning

confidence: 99%

Heart failure with preserved ejection fraction in humans and mice: embracing clinical complexity in mouse models

Withaar

Lam

Schiattarella

et al. 2021

European Heart Journal

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Heart failure (HF) with preserved ejection fraction (HFpEF) is a multifactorial disease accounting for a large and increasing proportion of all clinical HF presentations. As a clinical syndrome, HFpEF is characterized by typical signs and symptoms of HF, a distinct cardiac phenotype and raised natriuretic peptides. Non-cardiac comorbidities frequently co-exist and contribute to the pathophysiology of HFpEF. To date, no therapy has proven to improve outcomes in HFpEF, with drug development hampered, at least partly, by lack of consensus on appropriate standards for pre-clinical HFpEF models. Recently, two clinical algorithms (HFA-PEFF and H2FPEF scores) have been developed to improve and standardize the diagnosis of HFpEF. In this review, we evaluate the translational utility of HFpEF mouse models in the context of these HFpEF scores. We systematically recorded evidence of symptoms and signs of HF or clinical HFpEF features and included several cardiac and extra-cardiac parameters as well as age and sex for each HFpEF mouse model. We found that most of the pre-clinical HFpEF models do not meet the HFpEF clinical criteria, although some multifactorial models resemble human HFpEF to a reasonable extent. We therefore conclude that to optimize the translational value of mouse models to human HFpEF, a novel approach for the development of pre-clinical HFpEF models is needed, taking into account the complex HFpEF pathophysiology in humans.

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Section: Hfpef: a Heterogeneous Disease With Multiple Disease Mechanismsmentioning

confidence: 99%

Heart failure with preserved ejection fraction in humans and mice: embracing clinical complexity in mouse models

Withaar

Lam

Schiattarella

et al. 2021

European Heart Journal

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“…The concordance between the HFA-PEFF and H 2 FPEF scores was poor in our cohort with only 2.2% of subjects with unexplained dyspnoea identified as HFpEF by both scores. Confirmatory evidence for large discrepancies between HFpEF populations identified by either the HFA-PEFF or H 2 FPEF score comes from an 18 The ESC algorithm showed a slightly better concordance with both scores. One major reason might be that HFpEF is rather considered a clinical syndrome than a separate entity.…”

Section: Discussionmentioning

confidence: 90%

“… 7 Accordingly, even in an HFpEF cohort from the Maastricht, the Netherlands, HFpEF outpatient clinic, applying the HFA‐PEFF and the H 2 FPEF resulted in large discrepancies. 18 …”

Section: Discussionmentioning

confidence: 99%

Applying the ESC 2016, H₂FPEF, and HFA‐PEFF diagnostic algorithms for heart failure with preserved ejection fraction to the general population

Nikorowitsch¹,

Kellen²,

Kirchhof

et al. 2021

ESC Heart Failure

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Aims Heart failure with preserved ejection fraction (HFpEF) is common in patients presenting with dyspnoea. Recently, clinical tools were developed to facilitate the diagnosis of HFpEF. Here, we apply the European Society of Cardiology (ESC) 2016 heart failure guidelines and the H 2 FPEF and HFA-PEFF scores to a middle-aged sample of the general population and compared the different groups with each other. Methods and resultsThis study included the first 10 000 participants of the population-based Hamburg City Health Study. A total of 5613 subjects, aged 62 ± 8.7 years (51.1% women), qualified for the analysis. Unexplained dyspnoea was present in 407 (7.3%) subjects. In those, the estimated prevalence of HFpEF was 20.4% (ESC 2016), 12.3% (H 2 FPEF), and 7.6% (HFA-PEFF). The majority of subjects was classified as HFpEF not excludable according to the HFA-PEFF (57.7%) and H 2 FPEF (59.2%) scores. For all algorithms, subjects diagnosed with HFpEF showed elevated age and body mass index as well as a higher prevalence of atrial fibrillation, diabetes, and arterial hypertension compared with those without HFpEF or HFpEF not excludable. The distribution of those co-morbidities and risk factors varied between the differently diagnosed HFpEF groups with the highest burden in the HFpEF group defined by the H 2 FPEF score. The overlap of subjects diagnosed with HFpEF according to the different algorithms was very limited. Conclusions Unexplained dyspnoea is common in the middle-aged general population. The ESC 2016 algorithm and the H 2 FPEF and HFA-PEFF scores detect different, discordant subpopulations of probands with breathlessness. Further classification of the HFpEF syndrome is desirable.

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“…More recently, two score‐based algorithms (H 2 FPEF and HFA‐PEFF) have been proposed to aid the diagnosis 260 , 262 . While the generalizability of the scores has been tested in various trial and observational cohorts, their diagnostic performance has varied 263–270 …”

Section: Heart Failure With Preserved Ejection Fractionmentioning

confidence: 99%

2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure

McDonagh¹,

Metra²,

Adamo³

et al. 2022

European J of Heart Fail

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Document Reviewers: Rudolf A. de Boer (CPG Review Coordinator) (Netherlands), P. Christian Schulze (CPG Review Coordinator) (Germany), Magdy Abdelhamid (Egypt), Victor Aboyans (France), Stamatis Adamopoulos (Greece), Stefan D. Anker (Germany), Elena Arbelo (Spain), Riccardo Asteggiano (Italy), Johann Bauersachs (Germany), Antoni Bayes‐Genis (Spain), Michael A. Borger (Germany), Werner Budts (Belgium), Maja Cikes (Croatia), Kevin Damman (Netherlands), Victoria Delgado (Netherlands), Paul Dendale (Belgium), Polychronis Dilaveris (Greece), Heinz Drexel (Austria), Justin Ezekowitz (Canada), Volkmar Falk (Germany), Laurent Fauchier (France), Gerasimos Filippatos (Greece), Alan Fraser (United Kingdom), Norbert Frey (Germany), Chris P. Gale (United Kingdom), Finn Gustafsson (Denmark), Julie Harris (United Kingdom), Bernard Iung (France), Stefan Janssens (Belgium), Mariell Jessup (United States of America), Aleksandra Konradi (Russia), Dipak Kotecha (United Kingdom), Ekaterini Lambrinou (Cyprus), Patrizio Lancellotti (Belgium), Ulf Landmesser (Germany), Christophe Leclercq (France), Basil S. Lewis (Israel), Francisco Leyva (United Kingdom), AleVs Linhart (Czech Republic), Maja‐Lisa Løchen (Norway), Lars H. Lund (Sweden), Donna Mancini (United States of America), Josep Masip (Spain), Davor Milicic (Croatia), Christian Mueller (Switzerland), Holger Nef (Germany), Jens‐Cosedis Nielsen (Denmark), Lis Neubeck (United Kingdom), Michel Noutsias (Germany), Steffen E. Petersen (United Kingdom), Anna Sonia Petronio (Italy), Piotr Ponikowski (Poland), Eva Prescott (Denmark), Amina Rakisheva (Kazakhstan), Dimitrios J. Richter (Greece), Evgeny Schlyakhto (Russia), Petar Seferovic (Serbia), Michele Senni (Italy), Marta Sitges (Spain), Miguel Sousa‐Uva (Portugal), Carlo G. Tocchetti (Italy), Rhian M. Touyz (United Kingdom), Carsten Tschoepe (Germany), Johannes Waltenberger (Germany/Switzerland) All experts involved in the development of these guidelines have submitted declarations of interest. These have been compiled in a report and published in a supplementary document simultaneously to the guidelines. The report is also available on the ESC website http://www.escardio.org/guidelines For the Supplementary Data which include background information and detailed discussion of the data that have provided the basis for the guidelines see European Heart Journal online

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The HFA‐PEFF and H₂FPEF scores largely disagree in classifying patients with suspected heart failure with preserved ejection fraction

Cited by 48 publications

References 6 publications

Heart failure with preserved ejection fraction in humans and mice: embracing clinical complexity in mouse models

Heart failure with preserved ejection fraction in humans and mice: embracing clinical complexity in mouse models

Applying the ESC 2016, H₂FPEF, and HFA‐PEFF diagnostic algorithms for heart failure with preserved ejection fraction to the general population

2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure

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The HFA‐PEFF and H2FPEF scores largely disagree in classifying patients with suspected heart failure with preserved ejection fraction

Cited by 48 publications

References 6 publications

Heart failure with preserved ejection fraction in humans and mice: embracing clinical complexity in mouse models

Heart failure with preserved ejection fraction in humans and mice: embracing clinical complexity in mouse models

Applying the ESC 2016, H2FPEF, and HFA‐PEFF diagnostic algorithms for heart failure with preserved ejection fraction to the general population

2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure

Contact Info

Product

Resources

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The HFA‐PEFF and H₂FPEF scores largely disagree in classifying patients with suspected heart failure with preserved ejection fraction

Applying the ESC 2016, H₂FPEF, and HFA‐PEFF diagnostic algorithms for heart failure with preserved ejection fraction to the general population