Angina may provide additional diagnostic value in women with suspected heart failure with preserved ejection fraction (HFpEF). A cohort analysis published in Open Heart evaluated whether incorporating angina into the Heavy, Hypertensive, Atrial fibrillation, Pulmonary hypertension, Elder, Filling pressure (H2FPEF) score could modestly improve diagnostic performance.
The primary analysis included 515 individuals with suspected HFpEF from the UHFO-DM cohort who underwent standardized symptom assessment and expert-panel adjudication for HFpEF diagnosis. 

The association between angina and HFpEF independent of H2FPEF was evaluated using logistic regression. A modified H2FPEF score incorporating one additional point for angina was subsequently assessed for discrimination, calibration, reclassification, and decision curve performance. An additional external cohort of 751 individuals from the UHFO-COPD, STRETCH, and TREE studies was included for regression analysis.

In the UHFO-DM cohort, HFpEF prevalence was 24%. Overall, H2FPEF discrimination showed an area under the receiver operating characteristic curve (AUC) of 0.72, including 0.69 in women and 0.74 in men. Angina was independently associated with HFpEF in women (odds ratio [OR] 3.96, 95% confidence interval [CI] 1.72-9.11; P=0.001) but not in men.

Among women, adding one point for angina increased AUC from 0.69 to 0.71 (DeLong, P=0.030), improved sensitivity from 0.53 to 0.60, and increased negative predictive value from 0.80 to 0.82. A similar modification did not improve diagnostic performance in men.