Senthil Selvaraj1, Peder L Myhre2, Muthiah Vaduganathan3, Brian L Claggett3, Kunihiro Matsushita4, Dalane W Kitzman5, Barry A Borlaug6, Amil M Shah3, Scott D Solomon7. 1. Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. 2. Department of Cardiology, Division of Medicine, Akershus University Hospital, University of Oslo, Oslo, Norway; Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway. 3. Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts. 4. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 5. Sections on Cardiovascular Medicine, Department of Internal Medicine Wake Forest School of Medicine, Winston-Salem, North Carolina; Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina. 6. Division of Cardiology, Department of Medicine, Mayo Clinic, Rochester, Minnesota. 7. Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts. Electronic address: ssolomon@rics.bwh.harvard.edu.
Abstract
OBJECTIVES: This study sought to describe characteristics and risk of adverse outcomes associated with the H2FPEF and HFA-PEFF scores among participants in the community with unexplained dyspnea. BACKGROUND: Diagnosing heart failure with preserved ejection fraction (HFpEF) can be challenging. The H2FPEF and HFA-PEFF scores have recently been developed to estimate the likelihood that HFpEF is present among patients with unexplained dyspnea. METHODS: The study included 4,892 ARIC (Atherosclerosis Risk In Communities) study participants 67 to 90 years of age at visit 5 (2011 to 2013) without other common cardiopulmonary causes of dyspnea. Participants were categorized as asymptomatic (76.6%), having known HFpEF (10.3%), and having tertiles of each score among those with ≥moderate, self-reported dyspnea (13.1%). The primary outcome was heart failure (HF) hospitalization or death. RESULTS: Mean age was 75 ± 5 years, 58% were women, and 22% were black. After a mean follow-up of 5.3 ± 1.2 years, rates of HF hospitalization or death per 1,000 person-years for asymptomatic and known HFpEF were 20.7 (95% confidence interval [CI]: 18.9 to 22.7) and 71.6 (95% CI: 61.6 to 83.3), respectively. Among 641 participants with unexplained dyspnea, rates were 27.7 (95% CI: 18.2 to 42.1), 44.9 (95% CI: 34.9 to 57.7), and 47.3 (95% CI: 36.5 to 61.3) (tertiles of H2FPEF score) and 31.8 (95% CI: 20.3 to 49.9), 32.4 (95% CI: 23.4 to 44.9), and 54.3 (95% CI: 43.8 to 67.3) (tertiles of HFA-PEFF score). Participants with unexplained dyspnea and scores above the diagnostic threshold suggested for each algorithm, H2FPEF score ≥6 and HFA-PEFF score ≥5, had equivalent risk of HF hospitalization or death compared with known HFpEF. Among those with unexplained dyspnea, 28% had "discordant" findings (only high risk by 1 algorithm), while 4% were high risk by both. CONCLUSIONS: Participants with unexplained dyspnea and higher H2FPEF or HFA-PEFF scores face substantial risks of HF hospitalization or death. A significant fraction of patients are classified discordantly by using both algorithms.
OBJECTIVES: This study sought to describe characteristics and risk of adverse outcomes associated with the H2FPEF and HFA-PEFF scores among participants in the community with unexplained dyspnea. BACKGROUND: Diagnosing heart failure with preserved ejection fraction (HFpEF) can be challenging. The H2FPEF and HFA-PEFF scores have recently been developed to estimate the likelihood that HFpEF is present among patients with unexplained dyspnea. METHODS: The study included 4,892 ARIC (Atherosclerosis Risk In Communities) study participants 67 to 90 years of age at visit 5 (2011 to 2013) without other common cardiopulmonary causes of dyspnea. Participants were categorized as asymptomatic (76.6%), having known HFpEF (10.3%), and having tertiles of each score among those with ≥moderate, self-reported dyspnea (13.1%). The primary outcome was heart failure (HF) hospitalization or death. RESULTS: Mean age was 75 ± 5 years, 58% were women, and 22% were black. After a mean follow-up of 5.3 ± 1.2 years, rates of HF hospitalization or death per 1,000 person-years for asymptomatic and known HFpEF were 20.7 (95% confidence interval [CI]: 18.9 to 22.7) and 71.6 (95% CI: 61.6 to 83.3), respectively. Among 641 participants with unexplained dyspnea, rates were 27.7 (95% CI: 18.2 to 42.1), 44.9 (95% CI: 34.9 to 57.7), and 47.3 (95% CI: 36.5 to 61.3) (tertiles of H2FPEF score) and 31.8 (95% CI: 20.3 to 49.9), 32.4 (95% CI: 23.4 to 44.9), and 54.3 (95% CI: 43.8 to 67.3) (tertiles of HFA-PEFF score). Participants with unexplained dyspnea and scores above the diagnostic threshold suggested for each algorithm, H2FPEF score ≥6 and HFA-PEFF score ≥5, had equivalent risk of HF hospitalization or death compared with known HFpEF. Among those with unexplained dyspnea, 28% had "discordant" findings (only high risk by 1 algorithm), while 4% were high risk by both. CONCLUSIONS: Participants with unexplained dyspnea and higher H2FPEF or HFA-PEFF scores face substantial risks of HF hospitalization or death. A significant fraction of patients are classified discordantly by using both algorithms.
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