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H₂FPEF Score for HFpEF Probability

H₂FPEF (0–9) estimates the probability of heart failure with preserved ejection fraction in unexplained dyspnea: Heavy (BMI >30) 2, Hypertensive (≥2 drugs) 1, AF 3, Pulmonary hypertension (PASP >35) 1, Elder (>60) 1, Filling pressure (E/e′ >9) 1. 0–1 low, 2–5 intermediate (further testing), 6–9 high probability.

  • Body mass index (kg/m²)
  • Number of antihypertensive medications (drugs)
  • Atrial fibrillation (paroxysmal or persistent) (yes/no, +3)
  • Pulmonary artery systolic pressure (echo) (mmHg or kPa)
  • Age (years)
  • E/e′ ratio (echo) (ratio)
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Interpretation

ResultMeaning
0–1Low probability
2–5Intermediate: further testing
6–9High probability (> 90%)

Formula

H: BMI > 30 kg/m² 2 · H: ≥ 2 antihypertensive drugs 1 · F: atrial fibrillation 3 · P: PASP > 35 mmHg 1 · E: age > 60 1 · F: E/e′ > 9 1

Clinical pearls

  • Intended for euvolemic patients with unexplained dyspnea and LVEF ≥ 50%; it does not replace invasive hemodynamics when uncertain.
  • Atrial fibrillation alone contributes 3 points and is the strongest single predictor.

Examples

h2fpef bmi 34, 2 bp meds, paroxysmal af, pasp 40, age 68, e/e' 12hfpef probability for a 55 year old with bmi 28, one antihypertensive, no af, rvsp 30, E/e prime 8h2fpef 72F bmi 31 af no pasp 38 e/e 10 on 3 bp meds

FAQ

What H₂FPEF score rules in HFpEF?

Scores of 6–9 indicate high (over 90%) probability of HFpEF; 0–1 makes it unlikely.

Does H₂FPEF need natriuretic peptides?

No. It uses only clinical and echocardiographic variables, which is useful because BNP is often normal in obese HFpEF patients.

Evidence

  1. Reddy YNV et al. A simple, evidence-based approach to help guide diagnosis of heart failure with preserved ejection fraction. Circulation 2018;138:861–70.

Cardiology · Reviewed 2026-10-14 · Methodology