HFA-PEFF Score Calculator

HFA-PEFF Score: Explanation and Clinical Context The HFA-PEFF algorithm is a stepwise diagnostic approach for suspected heart failure with preserved ejection fraction (HFpEF) that uses three domains — functional (diastolic function / filling pressure and longitudinal strain), morphological (left atrial enlargement, left ventricular hypertrophy/geometry), and biomarkers (natriuretic peptides). Each domain contributes up to 2 points: any major criterion in a domain = 2 points; if no major but any minor criterion present = 1 point; otherwise 0. Scores range 0–6: a total ≥5 supports (rules in) HFpEF, 0–1 makes HFpEF unlikely (rule out), and scores 2–4 are indeterminate and prompt further functional testing (exercise echocardiography or invasive haemodynamics).

Key example thresholds used in this tool (from the HFA consensus): functional major — average E/e′ ≥15, TR peak velocity >2.8 m/s, or markedly reduced e′ (septal e′ <7 cm/s or lateral e′ <10 cm/s); functional minor — E/e′ 9–14 or LV global longitudinal strain (GLS) <16% (absolute). Morphological major — LAVI >34 mL/m² in sinus rhythm (or >40 mL/m² in atrial fibrillation), or concentric LV hypertrophy defined by sex-specific LV mass index thresholds with increased RWT; morphological minor — LAVI 29–34 mL/m² in sinus rhythm (34–40 in AF), LVMI mildly increased, RWT >0.42, or LV wall thickness ≥12 mm. Biomarker major/minor thresholds are rhythm-specific (example: NT-proBNP major >220 pg/mL in sinus rhythm, >660 pg/mL in AF; minor NT-proBNP 125–220 pg/mL in SR, 375–660 pg/mL in AF; equivalent BNP thresholds are lower).

This calculator implements those consensus thresholds to provide a structured, reproducible estimate of the likelihood of HFpEF. Clinical interpretation must integrate the complete clinical picture (symptoms, comorbidities, imaging quality, and alternative diagnoses). If the result is intermediate (score 2–4), proceed to Step F1 (functional testing: exercise echocardiography or invasive haemodynamic exercise testing) as recommended by the HFA consensus.