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H2FPEF Score — EECC MCQ

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ModerateHeart FailureH2FPEF ScoreEECC

A 58-year-old man with HFpEF and new AF asks about the H₂FPEF score. What does this score assess?

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Correct answer: AThe H₂FPEF score is a validated clinical prediction tool for diagnosing HFpEF using readily available parameters: Heavy (BMI >30), Hypertensive (≥2 antihypertensives), AF, Pulmonary hypertension (sPAP >35), Elder (>60), and Filling pressure (E/e' >9) — higher scores indicate higher probability of HFpEF

The H₂FPEF score (Reddy et al., Circulation 2018) was developed to discriminate HFpEF from non-cardiac dyspnoea in patients with preserved LVEF and unexplained exertional breathlessness. It uses 6 clinical and echocardiographic variables to calculate a probability score (0-9): H₂ = Heavy (BMI >30, 2 points); H = Hypertensive (≥2 antihypertensives, 1 point); F = AF (3 points); P = Pulmonary hypertension (echo sPAP >35 mmHg, 1 point); E = Elder (age >60, 1 point); F = Filling pressure (E/e' >9, 1 point). Score interpretation: 0-1 = low probability (<20%); 2-5 = intermediate (requires diastolic stress testing or invasive haemodynamics); 6-9 = high probability (>90%). The ESC 2023 HF Guidelines reference this alongside the HFA-PEFF algorithm as useful diagnostic tools for HFpEF.

Reference: ESC (2023): HF Guidelines; Reddy et al., Circulation 2018