Comparing the Prognostic Performance Using Various Diagnostic Scoring Systems in Heart Failure With Preserved Ejection Fraction: Insights From the Nationwide Prospective Registry.
Chang H, Huang W, et al. • Journal of the American Heart Association • 2026
Diagnostic scores for HFpEF can provide prognostic value, and the proposed simple echocardiography and natriuretic peptide-based TSOC-HFpEF scoring system offered superior risk discrimination compared with H2FPEF and HFA-PEFF scores.
Key Findings
Results
The newly proposed TSOC-HFpEF score demonstrated the highest discrimination for all-cause mortality among the three scoring systems evaluated.
TSOC-HFpEF score achieved a C-index of 0.65 for mortality discrimination
H2FPEF score had a C-index of 0.53 (P=0.001 vs TSOC-HFpEF by DeLong test)
HFA-PEFF score had a C-index of 0.57 (P=0.018 vs TSOC-HFpEF by DeLong test)
The TSOC-HFpEF score incorporated left ventricular mass index, left atrial volume index, E/e' ratio, tricuspid regurgitation velocity, and NT-proBNP level
Results
Mortality rates increased across TSOC-HFpEF score categories, ranging from 0.0 to 23.9 per 100 person-years.
The cohort consisted of 448 consecutive patients with HFpEF from the TSOC Heart Failure Registry 2020
Mean age was 77.0±10.6 years and 60.7% were women
Median follow-up was 2.0 years (interquartile range, 1.5–2.0 years)
The registry was nationwide, multicenter, prospective, and observational in design
Results
High-risk categories defined by the TSOC-HFpEF score were associated with significantly higher all-cause mortality compared with non-high-risk categories.
Hazard ratio for high-risk vs non-high-risk TSOC-HFpEF category: HR 3.35 (95% CI, 1.97–5.70)
High-risk HFA-PEFF category was also associated with higher all-cause mortality: HR 2.18 (95% CI, 1.17–4.07)
The association for the high-risk H2FPEF category was of borderline statistical significance: HR 1.55 (95% CI, 0.99–2.42); P=0.053
The TSOC-HFpEF score showed the largest magnitude of risk separation between high- and non-high-risk groups
Results
The H2FPEF score showed the weakest prognostic performance among the three scoring systems evaluated.
The high-risk H2FPEF category did not reach statistical significance for association with all-cause mortality (HR 1.55, 95% CI 0.99–2.42; P=0.053)
H2FPEF C-index of 0.53 was significantly lower than the TSOC-HFpEF C-index of 0.65 (P=0.001)
H2FPEF C-index was also numerically lower than HFA-PEFF C-index of 0.57
The H2FPEF score was one of the established scoring systems included for comparison alongside HFA-PEFF
Results
Renin-angiotensin system (RAS) inhibitor use was associated with lower mortality in patients with HFpEF.
This association was observed during a median follow-up of 2.0 years (interquartile range, 1.5–2.0 years)
RAS inhibitor use was identified as a prognostically relevant treatment variable in this HFpEF cohort
The finding was reported within the context of a prospective observational registry, not a randomized controlled trial
Methods
The study cohort was predominantly elderly and female, reflecting a typical HFpEF population.
Mean age was 77.0±10.6 years
60.7% of participants were women
448 consecutive patients were analyzed from the multicenter TSOC Heart Failure Registry 2020
Patients were enrolled from a nationwide prospective observational registry in Taiwan
What This Means
This research suggests that scoring systems originally designed to help diagnose heart failure with preserved ejection fraction (HFpEF) — a type of heart failure where the heart pumps normally but is too stiff — can also predict which patients are at higher risk of dying. The study compared three such scoring tools (H2FPEF, HFA-PEFF, and a newly proposed TSOC-HFpEF score) in 448 older adults (average age 77, mostly women) enrolled in a large Taiwanese heart failure registry. The newly developed TSOC-HFpEF score, which combines echocardiogram measurements of heart structure with a blood test called NT-proBNP, outperformed the other two established scores in distinguishing patients at high versus low risk of death.
Patients classified as 'high risk' by the TSOC-HFpEF score were more than three times as likely to die compared to those classified as lower risk, while the older H2FPEF score showed only a borderline, statistically marginal association with mortality. The study also found that use of medications that block the renin-angiotensin system (a class that includes ACE inhibitors and ARBs) was linked to lower mortality in this population. The median follow-up period was about two years.
This research suggests that choosing the right scoring tool matters when trying to identify HFpEF patients who need closer monitoring or more intensive care. A relatively simple combination of heart ultrasound measurements and a blood biomarker may provide better risk prediction than more complex or older tools, which could help clinicians prioritize care for the sickest patients with this difficult-to-manage condition.
Chang H, Huang W, Sung K, Cheng C, Wu H, Hsu C, et al.. (2026). Comparing the Prognostic Performance Using Various Diagnostic Scoring Systems in Heart Failure With Preserved Ejection Fraction: Insights From the Nationwide Prospective Registry.. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.125.047728