Diagnosing heart failure with preserved ejection fraction (HFpEF) in older adults remains challenging because symptoms often overlap with age-related cardiac changes and multiple comorbidities. A prospective study published in the Internal and Emergency Medicine evaluated the performance of commonly used HFpEF diagnostic algorithms in hospitalized older adults without a prior diagnosis of heart failure.

The study enrolled 200 inpatients aged older than 75 years who presented with at least one European Society of Cardiology (ESC)-listed sign or symptom suggestive of heart failure. All patients underwent assessment according to ESC 2021 HFpEF diagnostic criteria, including transthoracic echocardiography (TTE) and age-adjusted N-terminal pro-B-type natriuretic peptide (NT-proBNP) thresholds. 

Investigators also evaluated the diagnostic performance of the H₂FPEF and HFA-PEFF scores and tested a modified HFA-PEFF algorithm incorporating age-adjusted NT-proBNP and septal/lateral e′ velocity thresholds. The median patient age was 86.6 years, and 58.0% were women. Nearly all patients fulfilled ESC HFpEF criteria, while comorbid conditions were highly prevalent.

Findings

• A total of 96.0% of patients fulfilled ESC criteria for HFpEF.
• Transthoracic echocardiographic abnormalities were present in 95.0% of patients
• Elevated age-adjusted NT-proBNP levels were observed in 52.0% of patients.
• Confounding comorbidities were present in 98.0% of patients, including chronic kidney disease (60.0%) and infections (40.0%).
• The HFA-PEFF score classified 67.5% of patients as high probability, with sensitivity of 0.69, specificity of 0.75, and AUROC of 0.856.

The findings suggest that conventional HFpEF diagnostic algorithms may overclassify disease in older hospitalized adults because of overlapping comorbidities and age-related structural cardiac changes.