Author + information
- Received February 24, 2020
- Revision received March 24, 2020
- Accepted March 24, 2020
- Published online July 27, 2020.
- Senthil Selvaraj, MD, MAa,∗,
- Peder L. Myhre, MDb,c,∗,
- Muthiah Vaduganathan, MD, MPHd,
- Brian L. Claggett, PhDd,
- Kunihiro Matsushita, MDe,f,
- Dalane W. Kitzman, MDg,h,
- Barry A. Borlaug, MDi,
- Amil M. Shah, MD, MPHd and
- Scott D. Solomon, MDd,∗ ()
- aDivision of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- bDepartment of Cardiology, Division of Medicine, Akershus University Hospital, University of Oslo, Oslo, Norway
- cInstitute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- dDivision of Cardiology, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- eDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- fWelch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- gSections on Cardiovascular Medicine, Department of Internal Medicine Wake Forest School of Medicine, Winston-Salem, North Carolina
- hGeriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
- iDivision of Cardiology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
- ↵∗Address for correspondence:
Dr. Scott D. Solomon, Brigham and Women’s Hospital, Cardiovascular Division, 75 Francis Street, Boston, Massachusetts 02115.
Objectives This study sought to describe characteristics and risk of adverse outcomes associated with the H2FPEF and HFA-PEFF scores among participants in the community with unexplained dyspnea.
Background Diagnosing heart failure with preserved ejection fraction (HFpEF) can be challenging. The H2FPEF and HFA-PEFF scores have recently been developed to estimate the likelihood that HFpEF is present among patients with unexplained dyspnea.
Methods The study included 4,892 ARIC (Atherosclerosis Risk In Communities) study participants 67 to 90 years of age at visit 5 (2011 to 2013) without other common cardiopulmonary causes of dyspnea. Participants were categorized as asymptomatic (76.6%), having known HFpEF (10.3%), and having tertiles of each score among those with ≥moderate, self-reported dyspnea (13.1%). The primary outcome was heart failure (HF) hospitalization or death.
Results Mean age was 75 ± 5 years, 58% were women, and 22% were black. After a mean follow-up of 5.3 ± 1.2 years, rates of HF hospitalization or death per 1,000 person-years for asymptomatic and known HFpEF were 20.7 (95% confidence interval [CI]: 18.9 to 22.7) and 71.6 (95% CI: 61.6 to 83.3), respectively. Among 641 participants with unexplained dyspnea, rates were 27.7 (95% CI: 18.2 to 42.1), 44.9 (95% CI: 34.9 to 57.7), and 47.3 (95% CI: 36.5 to 61.3) (tertiles of H2FPEF score) and 31.8 (95% CI: 20.3 to 49.9), 32.4 (95% CI: 23.4 to 44.9), and 54.3 (95% CI: 43.8 to 67.3) (tertiles of HFA-PEFF score). Participants with unexplained dyspnea and scores above the diagnostic threshold suggested for each algorithm, H2FPEF score ≥6 and HFA-PEFF score ≥5, had equivalent risk of HF hospitalization or death compared with known HFpEF. Among those with unexplained dyspnea, 28% had “discordant” findings (only high risk by 1 algorithm), while 4% were high risk by both.
Conclusions Participants with unexplained dyspnea and higher H2FPEF or HFA-PEFF scores face substantial risks of HF hospitalization or death. A significant fraction of patients are classified discordantly by using both algorithms.
- H2FPEF score
- heart failure with preserved ejection fraction
- HFA-PEFF score
- risk scores
↵∗ Drs. Selvaraj and Myhre contributed equally to this work.
The ARIC study has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Department of Health and Human Services (contract numbers HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700004I, and HHSN268201700005I). The work for this manuscript was also supported by NIH grants R01HL135008 (to Dr. Shah), R01HL143224 (to Dr. Shah), and R01AG18915 (to Dr. Kitzman). Dr. Selvaraj is supported by the NIH (Training Grant 5-T32HL007843-23). Dr. Myhre is supported by a postdoctoral research grant from the South-Eastern Norway Regional Health Authority and the University of Oslo. Dr. Vaduganathan is supported by the KL2/Catalyst Medical Research Investigator Training award from Harvard Catalyst (NIH/National Center for Advancing Translational Sciences Award UL 1TR002541). Dr. Borlaug is supported by research funding from the NHLBI (R01 HL128526, R01 HL 126638, U01 HL125205, and U10 HL110262). Dr. Solomon is supported by research grants from the NHLBI. Dr. Myhre has received consulting fees from Novartis, Novo Nordisk, and AmGen; and speaker fees from Amgen. Dr. Vaduganathan has served on the advisory board for Amgen, AstraZeneca, Bayer AG, Baxter Healthcare, BIPI, Cytokinetics, and Relypsa; and served on clinical endpoint committees for studies sponsored by Novartis and the National Institutes of Health. Dr. Kitzman has received consulting fees from Novartis, Bayer, Merck, AstraZeneca, Pfizer, and Corvia. Dr. Shah has received research grant support from Novartis; and consulting fees from Philips Ultrasound and Bellerophon. Dr. Solomon has received research grant support from Alnylam, Amgen, AstraZeneca, Bellerophon, Bayer, Bristol-Myers Squibb, Celladon, Cytokinetics, Eidos, Gilead, GlaxoSmithKline, Ionis, Lone Star Heart, Mesoblast, MyoKardia, Novartis, Sanofi Pasteur, and Theracos; and served as a consultant for Akros, Alnylam, Amgen, Arena, AstraZeneca, Bayer, Bristol-Myers Squibb, Cardior, Cardurion, Corvia, Cytokinetics, Daiichi-Sankyo, Gilead, GlaxoSmithKline, Ironwood, Merck, Myokardia, Novartis, Roche, Takeda, Theracos, Quantum Genetics, Cardurion, AoBiome, Janssen, Cardiac Dimensions, Tenaya, Sanofi-Pasteur, Dinaqor, and Tremeau. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Heart Failure author instructions page.
- Received February 24, 2020.
- Revision received March 24, 2020.
- Accepted March 24, 2020.
- 2020 American College of Cardiology Foundation
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