Scoring logic: Heavy (BMI > 30) = 2, Hypertensive (≥ 2 meds) = 1, Atrial fibrillation = 3, Pulmonary HTN (PASP > 35) = 1, Elder (age > 60) = 1, Filling pressure (E/e′ > 9) = 1. Total: 0–9.
What is the H2FPEF score?
The H2FPEF score is a clinical tool used to estimate the likelihood that a patient with unexplained shortness of breath has heart failure with preserved ejection fraction (HFpEF). It combines six commonly available clinical and echocardiographic variables into a single score from 0 to 9.
In practical terms, the score helps clinicians organize data and decide whether HFpEF is less likely, possible, or highly likely. It does not replace clinical judgment or full cardiology workup.
How the calculator works
This calculator adds points from six domains:
- Heavy: BMI > 30 kg/m² → 2 points
- Hypertensive: Using 2 or more antihypertensive medications → 1 point
- AF: Atrial fibrillation present → 3 points
- Pulmonary hypertension: PASP > 35 mmHg → 1 point
- Elder: Age > 60 years → 1 point
- Filling pressure: E/e′ > 9 → 1 point
The final score is interpreted in risk bands:
- 0–1: Low probability of HFpEF
- 2–5: Intermediate probability (often needs additional testing)
- 6–9: High probability of HFpEF
Component-by-component interpretation
1) Obesity (Heavy)
Higher BMI is strongly associated with HFpEF pathophysiology, including impaired ventricular filling and systemic inflammation. In this score, obesity receives extra weight (2 points).
2) Blood pressure treatment burden (Hypertensive)
The use of multiple antihypertensive drugs can reflect chronic hypertension severity, a frequent driver of diastolic dysfunction and atrial remodeling.
3) Atrial fibrillation
Atrial fibrillation contributes significantly to symptoms and elevated filling pressures in HFpEF, and therefore gets the highest weight in this score (3 points).
4) Pulmonary pressure (PASP)
Elevated pulmonary artery systolic pressure may indicate backward transmission of high left-sided filling pressure, which is common in HFpEF.
5) Age (Elder)
HFpEF prevalence rises with age due to myocardial stiffness, vascular changes, and cumulative comorbidity burden.
6) E/e′ ratio
E/e′ is an echocardiographic estimate related to LV filling pressure. Higher values support the possibility of diastolic dysfunction in the appropriate clinical context.
Quick score interpretation table
| H2FPEF Score | Clinical Interpretation | Typical Next Step |
|---|---|---|
| 0–1 | Low likelihood of HFpEF | Consider alternative causes of dyspnea |
| 2–5 | Intermediate likelihood | Further echo/diastolic assessment, natriuretic peptides, stress testing, or specialist referral |
| 6–9 | High likelihood of HFpEF | Comprehensive HFpEF-oriented management and confirmation strategy |
Why this score is useful in everyday practice
- Uses variables commonly available in clinic and echocardiography reports
- Offers a structured way to triage diagnostic uncertainty
- Supports communication between primary care, internal medicine, and cardiology teams
- Can be repeated when new clinical data becomes available
Limitations to keep in mind
No score should be interpreted in isolation. Clinical presentation, biomarkers, imaging quality, rhythm status, and coexisting lung/kidney disease all matter. Borderline values can move a patient between categories, so quality of input data is important.
Medical disclaimer: This calculator is for educational and informational use only. It is not a diagnosis and does not replace evaluation by a qualified clinician. If you are concerned about symptoms such as breathlessness, edema, chest discomfort, or fatigue, seek professional medical care.