H2FPEF Score

What This Calculator Measures

Estimates the probability of heart failure with preserved ejection fraction (HFpEF) in patients with unexplained dyspnea, using clinical and echocardiographic features.

How to Use

1. Confirm the patient has unexplained dyspnea with a preserved (≥50%) left ventricular ejection fraction.
2. Record atrial fibrillation status, BMI, age, number of antihypertensives, E/e' ratio, and pulmonary artery systolic pressure.
3. Sum the points (0–9).
4. Use the result to guide further testing or to begin HFpEF therapy.

Interpretation Guide

Score 0–1: low probability of HFpEF (~6%); 2–5: intermediate (~10–46%) — consider further testing such as exercise echocardiography or invasive hemodynamics; 6–9: high probability (~67–95%) — HFpEF is very likely and treatment should be considered.

Clinical Significance

H2FPEF provides a practical, evidence-based framework for diagnosing HFpEF, reducing reliance on invasive testing while accurately identifying patients likely to benefit from HFpEF therapy.

When to Use

• Evaluation of unexplained exertional dyspnea with preserved LVEF
• Determining which dyspneic patients warrant HFpEF therapy
• Quantifying the diagnostic likelihood of HFpEF before invasive testing

When Not to Use

• Patients with reduced or mid-range LVEF — classify HFrEF/HFmrEF separately
• As a replacement for exercise testing or invasive hemodynamics in ambiguous cases

Limitations

• Derived from a referral population evaluated for unexplained exertional dyspnea; performance in general primary care cohorts is less certain.
• Requires echocardiographic data (E/e', PASP) that may not be available at first assessment.
• Does not include resting/exercise filling pressure data that may be needed in intermediate-risk patients.

Worked Example

A 66-year-old woman with persistent atrial fibrillation, BMI 32, taking 3 antihypertensives, has E/e' 11 and PASP 40 mmHg on echocardiography, with unexplained dyspnea.

H2FPEF score 9 — HIGH probability of HFpEF (~95%). HFpEF is very likely; proceed with HFpEF treatment.

Evidence

Source

Cardiology Literature

Reference

Reddy YNV, et al. Circulation. 2018;138(9):861-870.

Reviewed By

MedCalcHub Clinical Team

Version

2018

Updated

2026-08

1. Reddy YNV, et al. Circulation. 2018;138(9):861-870.

References

1. Reddy YNV, et al. A simple, evidence-based approach to help guide diagnosis of heart failure with preserved ejection fraction. Circulation. 2018;138(9):861-870. (Level II)