H2FPEF Score: Discriminates heart failure with preserved ejection fraction (HFpEF) from non-cardiac causes of dyspnea. Higher scores increase the likelihood of HFpEF.
Clinical & Echo Criteria
>60y = +1 pt
>9 = +1 pt
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Evaluation of patients with undifferentiated dyspnea and suspected Heart Failure with Preserved Ejection Fraction (HFpEF).
To discriminate between HFpEF and non-cardiac causes of dyspnea.
As an alternative to or in conjunction with the HFA-PEFF algorithm.
Section 2
Formula & Logic
Scoring Variables
H2: Heavy (BMI > 30)
2 pts
H: Hypertension (meds ≥ 2)
1 pt
A: Atrial Fibrillation (Paroxysmal or Persistent)
3 pts
P: Pulmonary Hypertension (PASP > 35 mmHg)
1 pt
E: Elder (Age > 60)
1 pt
F: Filling Pressures (E/e' > 9)
1 pt
Probability of HFpEF
Score 0-1
< 15% (Rule out)
Score 2-5
15-80% (Intermediate)
Score 6-9
> 90% (Rule in)
Section 3
Pearls/Pitfalls
H2FPEF vs. HFA-PEFF
The H2FPEF score is based on clinical and simple echocardiographic variables. It is often considered more "bedside-friendly" than the HFA-PEFF algorithm, which requires more complex echo parameters and often a stress test.
Section 4
Next Steps
Complementary Calculators
NT-proBNP Age-Adjusted Thresholds
LV Mass Index
EA Ratio
Seattle Heart Failure Model (SHFM)
MAGGIC Risk Score (Heart Failure)
Section 5
Evidence Appraisal
Primary Derivation
A Simple, Evidence-Based Approach to Help Guide Diagnosis of Heart Failure With Preserved Ejection Fraction.
Reddy YN et al. • Circulation.. 2018;n=414 (derivation) and n=100 (validation). C-statistic of 0.84.
