Prognostic Value Of H₂FPEF Score In Heart Failure Patients With Preserved Ejection Fraction

Background:In 2018,《Circulation》proposed a new set of H₂FPEF score,which is considered to be a simple method for diagnosing heart failure with preserved ejection fraction.However,whether the H₂FPEF score is related to the prognosis of HFp EF.The main purpose of this study is to evaluate the prognosis of HFp EF patients with H₂FPEF score.Methods:This is a retrospective,single-center,observational study.From January 2018 to December 2019,453 patients who met the diagnostic criteria in the chinese guidlines for the diagnosis and treatment of heart failure in the Department of Cardiology,the Second Hospital of Hebei Medical University,were included.Due to incomplete follow-up data,56 patients were excluded and 397 patients with HFp EF were included.All patients were collected for clinical general information,including gender,age,height,weight,smoking history,clinical medication,clinical laboratory indexes and echocardiography.According to the H₂FPEF score,the patients were divided into three groups:low-score group（H₂FPEF score 0-3）,intermediate-score group（H₂FPEF score 4-6）,high-score group（H₂FPEF score 7-9）.SPSS 25.0statistical software was used for data analysis.The counting data were expressed by frequency and percentage.Chi-square test and Fisher exact probability method were used.The measurement data of normal distribution were expressed as X±s,and the analysis of variance was used for comparison among groups.The measurement data of non-normal distribution were represented by M（Q₁,Q₃）.Kruskal Wallis H rank sum test was used for comparison among groups,and Kruskal Wallis H one-way ANOVA test was used for comparison among groups.Kaplan Meier was used to draw survival curves of three groups,and log rank test was performed.At the same time,Cox proportional hazards regression analysis was performed to evaluate the ability of H₂FPEF score to predict the readmission of patients with heart failure and the occurrence of composite cardiovascular events.Results:1.Comparison of general clinical data of different H₂FPEF score groups:The number of patients with atrial fibrillation and hypertension in high-score group were significantly more than those in intermediate-score and low-score groups.The use rate of CCB drugs and anticoagulants including warfarin and rivaroxaban in high-score group were significantly higher than those in intermediate-score and low-score groups（P<0.05）.The use rate of antiplatelet drugs including aspirin and clopidogrel in high-score group were significantly lower than the other two groups（P<0.05）.In high-score group,admission diastolic blood pressure,leave-hospital heart rate,admission heart rate,body mass index,Left atrial dimension,right atrial transverse diameter,right atrial superior inferior diameter,E/e’,systolic pulmonary artery pressure,creatinine,hemoglobin and uric acid were higher than that of intermediate-score group and low-score group,and there was statistical difference among the three groups（P<0.05）.2.Comparison of heart failure readmission and composite cardiovascular events in different H₂FPEF score groups:The average follow-up time of HFp EF patients was 22.15±6.84 months,100 patients and 80 patients had heart failure readmission and composite cardiovascular events respectively.The heart failure readmission rate and the incidence of composite cardiovascular events in the high-score group were significantly higher than those in the low-score group.Among them,the incidence of unstable angina in the high-score group was significantly higher than that in the low-score group（P<0.05）.3.Survival analysis of different H₂FPEF score groups:Kaplan-Meier analysis showed that people with high-score groups were more likely to have heart failure readmission（log-rank test,P=0.021）and composite cardiovascular events（log-rank test,P=0.018）.Cox risk ratio regression analysis showed that H₂FPEF score（HR 1.125,95%CI 1.006-1.258,P=0.040）and LAD（HR 1.049,95%CI 1.003-1.097,P=0.037）were an independent predictor of heart failure readmission.smoking history（HR 2.064,95%CI1.099-3.876,P=0.024）,E/e’（HR 1.039,95%CI 1.006-1.074,P=0.022）and H₂FPEF score（HR 1.138,95%CI 1.013-1.278,P=0.030）were an independent predictor of composite cardiovascular events.4.The ability of H₂FPEF score to predict heart failure readmission and composite cardiovascular events:The area under the ROC curve for predicting heart failure readmission and composite cardiovascular events were 0.590（95%CI 0.528-0.653,P=0.007）and 0.592（95%CI 0.519-0.665,P=0.011）.The best cut-off value of H₂FPEF score for predicting heart failure readmission and composite cardiovascular events was 6.5,and its sensitivity and specificity were 46.0%,66.7%and 50.0%,66.9%respectively.Conclusion:H₂FPEF score can be used as a predictor of the prognosis of heart failure with preserved ejection fraction.