Screening for heart failure with preserved ejection fraction using the BREATH2 score: diagnostic performance and prognostic value.

BACKGROUND

Heart failure with preserved ejection fraction (HFpEF) is more prevalent in aging societies and remains challenging to diagnose in primary care. The BREATH2 score is a screening tool for diagnosing HFpEF in Japanese primary care settings. However, its broader utility and association with cardiac outcomes are unclear.

OBJECTIVES

This study aimed to evaluate the diagnostic utility of the BREATH2 score for HFpEF and its prognostic value for cardiac event.

METHODS

This retrospective, single-center study examined 234 patients (median age 73 years; 25.6% female) with a left ventricular ejection fraction ≥ 50%. HFpEF was diagnosed using the HFA-PEFF algorithm. The BREATH2 scores were categorized as low (≤ 3), intermediate (4-5), or high (≥ 6) risk. Defined cardiac event was either cardiac death or HF hospitalization.

RESULTS

HFpEF prevalence rose progressively with the BREATH2 score, with 10.5% of participants in the low-, 38.6% in the intermediate-, and 70.3% in the high-risk groups. The BREATH2 score discriminated HFpEF from non-HFpEF better than the H₂FPEF score (AUC 0.81 vs. 0.69, P < 0.001). During the median follow-up period of 287 days, 17 (7.3%) patients experienced first cardiac event. Each 1-point increase in the BREATH2 score was associated with increased risk of a cardiac event (Hazard ratio 1.94, P < 0.001), independent of H₂FPEF or HFA-PEFF scores. Kaplan-Meier analysis demonstrated increasing cardiac event as the BREATH2 score increased.

CONCLUSIONS

The BREATH2 score was associated with HFpEF and more cardiac event, suggesting possible utility as a screening tool in primary care.