Discrepancies in Heart Failure With Preserved Ejection Fraction Scoring Systems: A Case Series

ABSTRACT Heart failure with preserved ejection fraction (HFpEF) accounts for up to 50% of total heart failure cases globally, and yet diagnosis remains a challenge. Popular scoring systems like the HFA‐PEFF and the H 2 FPEF have since been recommended by guidelines, but limitations exist in their utility. We present a series of four cases referred to our heart failure clinic for undifferentiated dyspnoea suspicious of HFpEF, highlighting several instances where such discrepancies exist and discuss the implications from each of these cases. Two of these cases include a cardiometabolic phenotype of HFpEF (HFA‐PEFF score 6 and H 2 FPEF score 1) and exercise‐inducible case of HFpEF (HFA‐PEFF score 1 and H 2 FPEF score 4), respectively, which scored very differently depending on the scoring systems used. In addition, two additional cases of HFpEF mimics—a case of hypertrophic cardiomyopathy (HFA‐PEFF score 6 and H 2 FPEF score 1) and of constrictive pericarditis (HFA‐PEFF score 0 and H 2 FPEF score 5)—also demonstrated discrepancies in total scores when employing these internationally recognised scoring systems. HFpEF remains a largely heterogenous condition, which limits the robustness of existing scoring systems and guideline‐recommended diagnostic algorithms. Our case series, we believe, highlights the importance of combining both inductive‐deductive reasoning and pattern recognition in diagnosing HFpEF or its many mimics. Our case series also highlights how the diagnosis of HFpEF should ideally go beyond these scoring systems and additional effort should be placed in exploring underlying aetiologies and in phenotyping patients with HFpEF and their mimics.