Comparing the Prognostic Performance Using Various Diagnostic Scoring Systems in Heart Failure With Preserved Ejection Fraction: Insights From the Nationwide Prospective Registry

Background Heart failure with preserved ejection fraction (HFpEF) remains challenging to diagnose, and several scoring systems have been developed to aid evaluation. Emerging evidence suggests that these scores provide prognostic information. This study assessed the prognostic utility of HFpEF scoring systems and compared their performance. Methods We analyzed data of 448 consecutive patients with HFpEF from a nationwide, multicenter, prospective, observational heart failure registry (TSOC [Taiwan Society of Cardiology] Heart Failure Registry 2020). We proposed the TSOC‐HFpEF score, which incorporated left ventricular mass index, left atrial volume index, E/e’ ratio, tricuspid regurgitation velocity, and N‐terminal pro‐brain natriuretic peptide level. Its prognostic performance was compared with that of H2FPEF and Heart Failure Association Pre‐test Assessment, Echocardiography and Natriuretic Peptide, Functional Testing, Final Etiology scores. Results The mean age of the cohort was 77.0±10.6 years, and 60.7% were women. Mortality rates increased across TSOC‐HFpEF scores, ranging from 0.0 to 23.9 per 100 person‐years. High‐risk categories defined by the Heart Failure Association Pre‐test Assessment, Echocardiography and Natriuretic Peptide, Functional Testing, Final Etiology and TSOC‐HFpEF scores were associated with higher all‐cause mortality than their respective non‐high‐risk categories (hazard ratio [HR], 2.18 [95% CI, 1.17–4.07] and HR, 3.35 [95% CI, 1.97–5.70], respectively), whereas the association for the high‐risk H2FPEF category was of borderline statistical significance (HR, 1.55 [95% CI, 0.99–2.42]; P =0.053). The TSOC‐HFpEF score had the highest discrimination for mortality (C‐index, 0.65) compared with the H2FPEF (C‐index, 0.53) and Heart Failure Association Pre‐test Assessment, Echocardiography and Natriuretic Peptide, Functional Testing, Final Etiology (C‐index, 0.57) scores ( P =0.001 and P =0.018, respectively, by DeLong test). Renin‐angiotensin system inhibitor use was associated with lower mortality during a median follow‐up of 2.0 years (interquartile range, 1.5–2.0 years). Conclusions Diagnostic scores for HFpEF can provide prognostic value. The proposed simple echocardiography and natriuretic peptide‐based scoring systems offered superior risk discrimination.