Sun Yuxi, Wang Niuniu, Li Xiao, Zhang Yanli, Yang Jie, Tse Gary, Liu Ying
Heart Failure and Structural Cardiology Division, Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, 193 United Road, Dalian, Liaoning, 116021, China.
Department of Cardiology, The Second Affiliated Hospital of Xuzhou Medical University, NO. 32 Meijian Road, Xuzhou, Jiangsu, 221000, China.
ESC Heart Fail. 2021 Apr;8(2):1244-1252. doi: 10.1002/ehf2.13187. Epub 2021 Jan 5.
The H FPEF score is a convenient risk stratification tool for diagnosing heart failure with preserved ejection fraction (HFpEF). This study examined the value of the H FPEF score for predicting all-cause mortality and rehospitalization in HFpEF patients.
This was a retrospective cohort study of patients diagnosed with HFpEF by echocardiography at a single tertiary centre between 1 January 2015 and 30 April 2018. According to the H FPEF score, the subjects were divided into low (0-1 points), intermediate (2-5 points), and high (6-9 points) score groups. The primary outcomes were all-cause mortality and rehospitalization. A total of 476 patients (mean age: 70.5 ± 8.4 years, 60.7% female) were included. Of these, 47 (9.9%), 262 (55.0%), and 167 (35.1%) were classified into the low, intermediate, and high score groups, respectively. Over a mean follow-up of 27.5 months, 63 patients (13.2%) died, and 311 patients (65.3%) were rehospitalized. The mortality rates were 3 (6.4%), 29 (11.1%), and 31 (18.6%), and the number of patients with rehospitalization was 28 (59.6%), 159 (60.7%), and 124 (74.3%) for the low, intermediate, and high score groups, respectively. Multivariate Cox regression identified H FPEF score as an independent predictor of all-cause mortality (hazard ratio [HR]: 1.46, 95% CI: 1.23-1.73, P < 0.0001) and rehospitalization (HR: 1.15, 95% CI: 1.08-1.22, P < 0.0001). Receiver operating characteristic (ROC) analysis demonstrated the H FPEF score can effectively predict all-cause mortality (AUC 0.67, 95% CI: 0.60-0.73, P < 0.0001) and rehospitalization (AUC 0.59, 95% CI: 0.54-0.65, P = 0.001) after adjusting for age and NYHA class. With a cut-off value of 5.5, the sensitivity and specificity were 68.3% and 55.4% for all-cause mortality and 50.5% and 66.7% for rehospitalization.
The H FPEF score can be used to predict prognosis in HFpEF patients. Higher scores are associated with higher all-cause mortality and rehospitalization.
HFpEF评分是用于诊断射血分数保留的心力衰竭（HFpEF）的一种便捷的风险分层工具。本研究探讨了HFpEF评分对预测HFpEF患者全因死亡率和再住院率的价值。
这是一项回顾性队列研究，研究对象为2015年1月1日至2018年4月30日期间在某单一三级中心通过超声心动图诊断为HFpEF的患者。根据HFpEF评分，将研究对象分为低（0 - 1分）、中（2 - 5分）、高（6 - 9分）评分组。主要结局为全因死亡率和再住院率。共纳入476例患者（平均年龄：70.5±8.4岁，60.7%为女性）。其中，47例（9.9%）、262例（55.0%）和167例（35.1%）分别被归入低、中、高评分组。在平均27.5个月的随访期内，63例患者（13.2%）死亡，311例患者（65.3%）再次住院。低、中、高评分组的死亡率分别为3例（6.4%）、29例（11.1%）和31例（18.6%），再住院患者数分别为28例（59.6%）、159例（60.7%）和124例（74.3%）。多因素Cox回归分析确定HFpEF评分是全因死亡率（风险比[HR]：1.46，95%可信区间[CI]：1.23 - 1.73，P < 0.0001）和再住院率（HR：1.15，95% CI：1.08 - 1.22，P < 0.0001）的独立预测因素。受试者工作特征（ROC）分析表明，在校正年龄和纽约心脏病协会（NYHA）心功能分级后，HFpEF评分可有效预测全因死亡率（曲线下面积[AUC] 0.67，95% CI：0.60 - 0.73，P < 0.0001）和再住院率（AUC 0.59，95% CI：0.54 - 0.65，P = 0.001）。对于全因死亡率，截断值为5.5时，敏感性和特异性分别为68.3%和55.4%；对于再住院率，敏感性和特异性分别为50.5%和66.7%。
HFpEF评分可用于预测HFpEF患者的预后。评分越高，全因死亡率和再住院率越高。
