An evidence-based tool for screening for heart failure with preserved ejection fraction in primary care: The BREATH2 score
Yuki Saito, Nobuyuki Kagiyama, Tomonari Harada, Tomohiro Kaneko, Kazuki Kagami, Taishi Dotare, Naoki Yuasa, Eiichiro Sato, Hidemi Sorimachi, Azusa Murata, Masashi Kawagoshi, Yoichi Nishiya, Atsutaka Yasui, Yasuo Okumura, Tohru Minamino, Hideki Ishii, Masaru Obokata
Abstract
Background Heart failure with preserved ejection fraction (HFpEF) remains underdiagnosed in primary care settings, where echocardiography is not available. This study aimed to develop and validate a scoring system that does not include echocardiographic variables for HFpEF screening among patients with shortness of breath. Methods A total of 622 consecutive patients referred for exercise stress echocardiography were evaluated (283 HFpEF and 339 controls). Diagnosis of HFpEF was determined by the HFA-PEFF algorithm Steps 2–3. Results Multivariable logistic regression analysis identified age ≥65 years, coronary artery disease, elevated natriuretic peptide levels, anemia, cardiomegaly on chest radiography, and left ventricular high-voltage on electrocardiogram as independent predictors of having HFpEF. A weighted score, including the six predictors and atrial fibrillation, was created (BREATH 2 score). The BREATH 2 score accurately discriminated HFpEF from controls [area under the curve (AUC) 0.84, p < 0.0001], with a superior diagnostic ability to the H 2 FPEF score. The diagnostic accuracy was confirmed in an external validation cohort ( n = 105, AUC 0.78, p < 0.0001) and in patients whose diagnosis was determined by exercise right heart catheterization ( n = 79, AUC 0.75, p = 0.0001). The BREATH 2 score classified each patient into different risk categories of having HFpEF, ranging from 4 % to 93 %. Conclusions The BREATH 2 score can be an effective screening tool in primary care settings to help refer patients to a secondary hospital for further evaluation.