{
  "abstract": "Background Diagnosing heart failure with preserved ejection fraction (HFpEF) remains challenging, particularly in older adults. While the Heart Failure Association (HFA)-PEFF and H 2FPEF Scores offer structured diagnostic approaches, their clinical utility is still debated. This study aims to compare the diagnostic accuracy of HFpEF Scores versus inclusion criteria used in sodium-glucose cotransporter-2 inhibitors (SGLT2i) trials, age-adjusted N-terminal pro B-type natriuretic peptide (NT-proBNP) thresholds and the universal definition of heart failure (HF).Methods Diagnostic tools were assessed using sex-weighted and age-weighted propensity score adjustment in individuals aged 60–80 years from two established HFpEF cohorts (MEtabolic Road to DIAstolic Heart Failure (MEDIA), n=297; Karolinska-Rennes (KaRen), n=174) and two community-based cohorts without HF (Suivi Temporaire Annuel Non-Invasif de la Santé des Lorrains Assurés Sociaux (STANISLAS), n=461; Malmö, n=1030).Results HFA-PEFF and H 2FPEF Scores classified a large proportion of participants in both community-based cohorts (up to 81% in Malmö) and HFpEF cohorts (up to 75% in MEDIA) in the intermediate-likelihood category, requiring further diagnostic evaluation. Their diagnostic discrimination ranged from moderate to good. The universal definition of HF, SGLT2i trial criteria and NT-proBNP age-adjusted thresholds showed diagnostic performance comparable to HFA-PEFF Scores in the HFpEF cohorts and correctly excluded almost all individuals in the community cohorts. The universal definition of HF demonstrated a diagnostic discrimination higher than H2FPEF and comparable to HFA-PEFF, with the most balanced performance in terms of sensitivity and specificity.Conclusions Using scores, a substantial proportion of HFpEF individuals fall into the intermediate likelihood category, highlighting diagnostic uncertainty. Simpler tools, such as the universal definition of HF, demonstrate comparable or even superior diagnostic and rule-out performances for HFpEF, emphasising the need for more practical and reliable approaches to HFpEF diagnosis.",
  "authors": [
    {
      "affiliations": [
        "Université de Lorraine, Centre d’Investigations Cliniques Plurithématique 1433 and INSERM U1116 - DCAC, CHRU Nancy, and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France"
      ],
      "name": "Luca Monzo"
    },
    {
      "affiliations": [
        "Université de Lorraine, Centre d’Investigations Cliniques Plurithématique 1433 and INSERM U1116 - DCAC, CHRU Nancy, and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France"
      ],
      "name": "Olivier Huttin"
    },
    {
      "affiliations": [
        "Winters Center for Heart Failure, Baylor College of Medicine, Houston, Texas, USA"
      ],
      "name": "Biykem Bozkurt"
    },
    {
      "affiliations": [
        "Université de Lorraine, Centre d’Investigations Cliniques Plurithématique 1433 and INSERM U1116 - DCAC, CHRU Nancy, and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France"
      ],
      "name": "Kévin Duarte"
    },
    {
      "affiliations": [
        "Heart and Vascular Theme, Heart Failure Section, Karolinska University Hospital, Stockholm, Sweden",
        "Department of Medicine, Cardiology Unit, Karolinska Institutet, Stockholm, Sweden"
      ],
      "name": "Cecilia Linde"
    },
    {
      "affiliations": [
        "Heart and Vascular Theme, Heart Failure Section, Karolinska University Hospital, Stockholm, Sweden",
        "Department of Medicine, Cardiology Unit, Karolinska Institutet, Stockholm, Sweden"
      ],
      "name": "Lars H Lund"
    },
    {
      "affiliations": [
        "Heart and Vascular Theme, Heart Failure Section, Karolinska University Hospital, Stockholm, Sweden",
        "Department of Medicine, Cardiology Unit, Karolinska Institutet, Stockholm, Sweden"
      ],
      "name": "Camilla Hage"
    },
    {
      "affiliations": [
        "Departement of Cardiology and CIC-IT U804, Rennes University Hospital, Rennes, France"
      ],
      "name": "Erwan Donal"
    },
    {
      "affiliations": [
        "Department of Clinical Sciences, Lund University, Malmö, Sweden",
        "Department of Cardiology, Skåne University Hospital, Malmö, Sweden",
        "Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden",
        "Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa"
      ],
      "name": "Martin Magnusson"
    },
    {
      "affiliations": [
        "Department of Clinical Sciences, Lund University, Malmö, Sweden",
        "Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden"
      ],
      "name": "Peter Nilsson"
    },
    {
      "affiliations": [
        "Department of Clinical Sciences, Lund University, Malmö, Sweden",
        "Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden"
      ],
      "name": "Margret Leosdottir"
    },
    {
      "affiliations": [
        "Université de Lorraine, Centre d’Investigations Cliniques Plurithématique 1433 and INSERM U1116 - DCAC, CHRU Nancy, and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France"
      ],
      "name": "Erwan Bozec"
    },
    {
      "affiliations": [
        "Université de Lorraine, Centre d’Investigations Cliniques Plurithématique 1433 and INSERM U1116 - DCAC, CHRU Nancy, and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France"
      ],
      "name": "Guillaume Baudry"
    },
    {
      "affiliations": [
        "Université de Lorraine, Centre d’Investigations Cliniques Plurithématique 1433 and INSERM U1116 - DCAC, CHRU Nancy, and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France"
      ],
      "name": "Faiez Zannad"
    },
    {
      "affiliations": [
        "Université de Lorraine, Centre d’Investigations Cliniques Plurithématique 1433 and INSERM U1116 - DCAC, CHRU Nancy, and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France"
      ],
      "name": "Nicolas Girerd"
    }
  ],
  "title": "Comparing diagnostic tools for heart failure with preserved ejection fraction across community and clinical cohorts",
  "uid": "d6bccfff-bec0-50af-ba58-e3cd8fa5e51d"
}