HFpEF probability scores rule out disease but show limitations in AF and obesity phenotypesHFpEF probability scores work well for typical cases but struggle with atrial fibrillation and obesity

This systematic review assessed the strengths and limitations of HFpEF probability scales, specifically HFA-PEFF and H2FPEF, within the context of precision medicine strategies. The study focused on patients diagnosed with heart failure with preserved ejection fraction (HFpEF), with particular attention to subgroups characterized by atrial fibrillation and obesity. The primary objective was to determine the diagnostic performance and applicability of these probability scores across varying clinical phenotypes.

The review found that both HFA-PEFF and H2FPEF scores are effective at capturing typical HFpEF presentations. Furthermore, the data suggests that these scores can successfully rule out disease in patients presenting with low scores. These findings support the utility of probability scales for initial diagnostic stratification in standard HFpEF populations.

However, significant limitations were identified in specific patient phenotypes. In patients with atrial fibrillation, the scores face challenges because the condition alters natriuretic peptide levels and echocardiographic parameters, which are foundational to the scoring algorithms. Similarly, in patients with obesity, the diagnostic accuracy is impaired because obesity itself affects natriuretic peptide-based diagnostics.

The study highlights that while these tools are useful for typical presentations, they require careful interpretation when applied to patients with comorbidities like atrial fibrillation or obesity. The authors note that precision medicine strategies, such as the use of GLP-1 receptor agonists for obesity-related HFpEF, underscore the need for phenotype-specific therapeutic approaches. Consequently, HFpEF probability scores must be interpreted within the context of individual patient phenotypes to avoid diagnostic errors.