AUTHOR=Schrutka Lore , Seirer Benjamin , Rettl René , Dachs Theresa-Marie , Binder Christina , Duca Franz , Dalos Daniel , Badr-Eslam Roza , Kastner Johannes , Hengstenberg Christian , Frommlet Florian , Bonderman Diana 

TITLE=Heart failure with preserved ejection fraction: Calculating the risk of future heart failure events and death

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=9

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.921132

DOI=10.3389/fcvm.2022.921132

ISSN=2297-055X

ABSTRACT=<sec><title>Objective</title><p>We sought to develop a clinical model to identify heart failure patients with preserved ejection fraction (HFpEF) at highest risk for acute HF events or death.</p></sec><sec><title>Methods and results</title><p>Between 2010 and 2019, 422 patients with HFpEF were followed. Acute HF events occurred in 190 patients (45%), including 110 (58%) with recurrent hospitalizations. Those with recurrent events had worse 6-min walk test (<italic>p</italic> &lt; 0.001), higher brain N-terminal prohormone natriuretic peptide (NT-proBNP, <italic>p</italic> &lt; 0.001), and higher New York Heart Association functional class (NYHA, <italic>p</italic> &lt; 0.001). Overall survival rates in patients with 1 HF event vs &gt; 1 HF events were: at 1-year 91.6 vs. 91.8%, at 3-years 84.7 vs. 68.3% and at 5-years 67.4 vs. 42.7%, respectively (<italic>p</italic> &lt; 0.04). The Hfpef survivAL hOspitalization (HALO) score revealed best predictive capability for all-cause mortality combining the variables age (<italic>p</italic> = 0.08), BMI (<italic>p</italic> = 0.124), NYHA class (<italic>p</italic> = 0.004), need for diuretic therapy (<italic>p</italic> = 0.06), left atrial volume index (<italic>p</italic> = 0.048), systolic pulmonary artery pressure (<italic>p</italic> = 0.013), NT-proBNP (<italic>p</italic> = 0.076), and number of prior hospitalizations (<italic>p</italic> = 0.006). HALO score predicted future HF hospitalizations in an ordinal logistic regression model (OR 3.24, 95% CI: 2.45–4.37, <italic>p</italic> &lt; 0.001). The score performance was externally validated in 75 HFpEF patients, confirming a strong survival prediction (HR 2.13, 95% CI: 1.30–3.47, <italic>p</italic> = 0.002).</p></sec><sec><title>Conclusions</title><p>We developed a model to identify HFpEF patients at increased risk of death and HF hospitalization. NYHA class and recurrent HF hospitalizations were the strongest drivers of outcome.</p></sec>