Risk stratification in heart failure with preserved ejection fraction (HFpEF) remains challenging despite the availability of diagnostic scoring systems. This participant-level pooled analysis of clinical trials, published in the Journal of Cardiac Failure, examined whether established HFpEF diagnostic models are associated with clinical outcomes in patients with confirmed disease.
Data from five major clinical trials, including CHARM-Preserved, I-Preserve, TOPCAT-Americas, PARAGON-HF, and DELIVER, were combined, including 15,318 participants with HFpEF. Patients were categorized based on the HFpEF-ABA score into low/intermediate (38%) and high HFpEF-ABA score (62%) groups.

The primary outcomes included cardiovascular death and heart failure hospitalization. Additional analyses using echocardiographic data from TOPCAT-Americas and PARAGON-HF (n=1,300) evaluated associations of HFpEF-ABA, H2FPEF, and HFA-PEFF scores with clinical outcomes.

Higher HFpEF-ABA scores were associated with higher rates of adverse outcomes. Patients in the high-score group had a 75% higher rate of cardiovascular death or HF hospitalization compared with those in the low/intermediate group (hazard ratio [HR] 1.75; 95% CI 1.62–1.89; p<0.001).

However, overall risk discrimination was limited (C statistic 0.559; 95% CI 0.550–0.567). Treatment effects across trials appeared consistent regardless of HFpEF-ABA score category. In the echocardiographic subset, only H2FPEF (HR per unit increase 1.06; 95% CI 1.00–1.11) and HFA-PEFF (HR 1.10; 95% CI 1.03–1.19) scores were significantly associated with outcomes, though predictive performance remained modest (C statistic range 0.524–0.529).

These findings indicate that while HFpEF diagnostic scores were associated with adverse outcomes, their utility for risk stratification after diagnosis remains limited.