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H2FPEF Score for Heart Failure with Preserved Ejection Fraction

Calculator provides a continuous probability estimate.

When to use

Patient with exertional dyspnea of unclear origin
Preserved LVEF (≥50%)
Suspected HFpEF after initial clinical evaluation
Borderline echocardiographic findings
Prior to invasive hemodynamic assessment
Ambulatory HFpEF diagnostic workup
Particularly useful when differentiating:
- HFpEF vs. pulmonary disease
- HFpEF vs. obesity/deconditioning
- HFpEF vs. non-cardiac dyspnea

Pearls/Pitfalls

Pitfalls

Atrial fibrillation strongly increases probability
Does not include natriuretic peptides
Not validated in:
- Significant valvular disease
- Infiltrative cardiomyopathy
- Advanced pulmonary hypertension
Obesity-related dyspnea may inflate estimated probability
Should not replace comprehensive clinical evaluation

Clinical Pearls

High calculated probability correlates with elevated filling pressures
In obese elderly patients with AF, probability often exceeds 80%
Low probability should prompt evaluation for pulmonary or deconditioning as a cause of dyspnea
Best used within a structured HFpEF diagnostic pathway
Consider invasive exercise hemodynamics if probability is intermediate and clinical suspicion remains high

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Why Use

Provides estimated probability (%), not just risk categories
Supports individualized diagnostic decision-making
Uses widely available variables:
- BMI
- Antihypertensive treatment (≥2 drugs)
- Atrial fibrillation
- Age >60
- Pulmonary artery systolic pressure
- E/e’
Helps determine:
- Low probability → alternative diagnosis likely
- Intermediate probability → consider further testing
- High probability → HFpEF very likely

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Michal Pazdernik, MD, Ph.D.
Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic

michal.pazdernik@ikem.cz

+420 602 258 544

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