Diagnosis of heart failure with preserved ejection fraction (HFpEF) in routine practice remains challenging because of heterogeneous symptoms and overlapping comorbidities. In a multicenter retrospective study presented at the Heart Failure 2026, investigators evaluated the prevalence of probable HFpEF using the H2FpEF score among patients referred to outpatient cardiology clinics for heart failure-like symptoms.
The study included patients referred for an initial cardiology evaluation at three Dutch general hospitals between February 2024 and August 2025. Eligible patients presented with symptoms suggestive of heart failure, including dyspnea, edema, or fatigue, without a prior history of heart failure.
Findings
- A total of 306 patients with heart failure-like symptoms were evaluated.
- Among these, 280 patients (81.5%) had an available echocardiogram and were included in the primary analysis.
- Of patients with preserved left ventricular ejection fraction (≥50%) and no severe valvular disease, 179 patients formed the HFpEF evaluation cohort.
- The cohort demonstrated a high prevalence of HFpEF-associated risk factors, including age >60 years in 91.1%, female sex in 58.1%, and body mass index >30 kg/m² in 37.7%.
- An H2FpEF score could be calculated in 78.2% of eligible patients.
- Among those with available scores, 36.4% had an H2FpEF score ≥5, corresponding to a moderate probability of HFpEF.
- One in five patients (20%) had an H2FpEF score ≥6, indicating a high probability of HFpEF.
- HFpEF was included in the physician differential diagnosis in only 24.6% of cases.
The findings suggest that HFpEF may remain underrecognized in routine outpatient cardiology practice despite a substantial proportion of symptomatic patients meeting likelihood-based diagnostic criteria.
