The score paves the way for diagnosing more patients with unexplained shortness of breath, according to researchers.


Summary: A new study published in Nature Medicine demonstrates the effectiveness of the HFpEF-ABA scoring system in diagnosing heart failure with preserved ejection fraction (HFpEF). This simple model, using age, BMI, and atrial fibrillation, aids in identifying HFpEF, particularly in patients with unexplained shortness of breath. The score improves early diagnosis and treatment, potentially elevating the standard of care for HFpEF patients.

Key Takeaways:

  1. Simplified Diagnosis: The HFpEF-ABA score uses three clinical variables—age, BMI, and atrial fibrillation—to identify HFpEF.
  2. Improved Care: Early detection with the HFpEF-ABA score may enable timely treatment with newly approved drugs, improving patient outcomes and prognosis.
  3. Wide Validation: The scoring system was validated across diverse populations in multiple countries.

A new study demonstrates the effectiveness of a newly developed scoring system in identifying patients with heart failure with preserved ejection fraction (HFpEF). 

The HFpEF-ABA score, which incorporates age, body mass index (BMI), and atrial fibrillation to aid in the diagnosis of HFpEF, has the potential to improve the diagnostic approach to HFpEF, particularly in patients with unexplained dyspnea, or shortness of breath, a major clinical issue, according to the researchers.

With the new, simple scoring system, “We are able to screen and effectively identify patients with a high probability of HFpEF at the population level. We’re tapping into an opportunity to elevate the standard of care, and it will change the paradigm for diagnosis for better identification of HFpEF at the community level,” says Varun Sundaram, MD, PhD, MSc, FRCP (UK), a heart failure cardiologist at University Hospitals Harrington Heart & Vascular Institute, associate professor at Case Western Reserve University School of Medicine, and the section chief of advanced heart failure at the Louis Stokes Cleveland Veteran Affairs Medical Center, in a release.

The study was published in Nature Medicine.

The HFpEF Score

The HFpEF score was derived and validated using data from large academic centers in Australia, Belgium, Denmark, Japan, the Netherlands, and the United States, including Johns Hopkins Medicine, the Medical University of South Carolina, Mayo Clinic, and the VA, with the largest cohort being from the VA Medical Centers (n> 3,000).

Diagnosing HFpEF at the population level presents significant complexity and challenges, especially in a primary care setting, due to the multitude of variables involved in each patient’s diagnosis. Many HFpEF patients remain undiagnosed for extended periods, often until their heart failure conditions have significantly progressed.

Simplified Screening Model

The newly developed HFpEF-ABA score model estimates the probability of HFpEF in individual patients based on three simple clinical variables: age, BMI, and atrial fibrillation. This model does not require sophisticated imaging for initial screening, making it accessible and practical for use in various healthcare settings, including primary care and rural areas.

Patients identified as having a high probability of HFpEF can then be referred for further imaging, such as echocardiography and cardiac catheterization if needed. Additionally, these patients can be initiated on newly approved drugs for HFpEF, including SGLT-2 inhibitors (SGLT-2i) and GLP-1 receptor agonists (GLP-1RA) in a timely manner, thereby improving their prognosis and long-term outcomes.

Impact on Heart Failure Diagnosis

“We are very encouraged with the clinical implication of the study results,” says Sundaram in a release. Screening patients for HFpEF with the new scoring system “is something simple and quick that can easily be done by anyone in a primary care setting or urgent care.”

In the United States, there are roughly 6 million heart failure patients, and that number is expected to reach eight million by 2030, driven largely by the increase in the elderly population, and obesity. At least half of those patients will likely be diagnosed with HFpEF, the fastest-growing type of heart failure, according to Sundaram. The diagnosis and treatment of HFpEF is very different to other forms of heart failure, which makes early screening, diagnosis and treatment key, to avail patients of new and emerging therapies.

“By improving our ability to identify these patients, physicians can respond more quickly and effectively to treat their specific conditions,” Sundaram says in a release. “The new score was designed to address this need. It is a straightforward scoring model that has demonstrated excellent performance across diverse populations.”

Sundaram and his team believe a significant proportion of the population has undiagnosed HFpEF. Future research will focus on determining the best strategies to encourage clinicians to adopt the new HFpEF-ABA scoring system. This will help identify patients with a high probability of HFpEF and direct them toward appropriate clinical pathways for timely diagnosis and treatment, including newly available drug options.

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