H2FPEF Score (Heart Failure with Preserved EF Probability) Calculator

H2FPEF Score: Explanation and Clinical Context The H2FPEF Score is a validated diagnostic scoring system designed to estimate the likelihood of heart failure with preserved ejection fraction (HFpEF) in patients presenting with unexplained dyspnea. It integrates six easily measurable clinical and echocardiographic variables: Heavy (BMI ≥30 kg/m²), Hypertensive (≥2 antihypertensive medications), Atrial fibrillation, Pulmonary artery systolic pressure >35 mmHg, Age >60 years, and E/e′ >9. Each variable contributes a weighted score (2 points for obesity, 3 points for atrial fibrillation, and 1 point for the others), resulting in a total score ranging from 0 to 9.

The score correlates with the estimated probability of HFpEF based on logistic regression modeling derived from invasive hemodynamic validation cohorts. A total score of ≤1 indicates a low probability of HFpEF (≤25%), scores of 2–5 represent intermediate probability (~50%), and scores ≥6 correspond to a high probability (≥90%) of HFpEF. This model assists clinicians in distinguishing HFpEF from non-cardiac causes of dyspnea, potentially reducing unnecessary invasive testing.

Clinical Interpretation Summary: The H2FPEF score complements, but does not replace, comprehensive clinical judgment and echocardiographic assessment. It should be applied alongside natriuretic peptide levels, diastolic function indices, and, when available, invasive hemodynamic measurements. Its simplicity and accuracy make it a useful bedside and research tool in the diagnostic algorithm for HFpEF.