H2FPEF Score and Charlson Comorbidity Index as Independent Predictors of Cardiovascular Outcomes in Elderly Patients Undergoing Geriatric Rehabilitation.
Dayer N, Auberson D, et al. • Clinical cardiology • 2026
In geriatric inpatients, a high H2FPEF score is common and independently identifies patients at increased risk of adverse cardiovascular outcomes at 1 year.
Key Findings
Results
A high H2FPEF score (≥6) was present in 24% of geriatric rehabilitation inpatients, indicating high HFpEF probability in a substantial proportion of this population.
Study included 302 consecutive patients admitted to a geriatric rehabilitation unit
Median age was 83 years, with 40% men
24% had a H2FPEF score ≥6 indicating high HFpEF probability
42% had a Charlson Comorbidity Index (CCI) >3 indicating high comorbidity burden
All patients underwent functional and echocardiographic assessment at admission
Results
A high H2FPEF score was independently associated with a nearly threefold higher risk of 1-year all-cause mortality or cardiovascular rehospitalization.
Adjusted HR 2.89 (95% CI 1.63–5.10), p < 0.001 for combined outcome of 1-year all-cause mortality (ACM) or cardiovascular rehospitalization (CR)
This association was independent of comorbidity burden as measured by the CCI
No interaction was found between H2FPEF score and CCI (p = 0.63), confirming independent predictive value
The analysis was adjusted for relevant covariates in a prospective cohort design
Results
A high Charlson Comorbidity Index (CCI >3) was independently associated with a similarly elevated risk of 1-year all-cause mortality or cardiovascular rehospitalization.
Adjusted HR 2.66 (95% CI 1.67–4.21), p < 0.001 for combined outcome of ACM or CR
CCI predicted adverse outcomes independently of H2FPEF score
No statistically significant interaction was detected between high CCI and high H2FPEF score (p = 0.63)
Results
Patients with both a high H2FPEF score and a high CCI had the highest risk of adverse cardiovascular outcomes.
Adjusted HR 4.66 (95% CI 2.54–8.57), p < 0.001 for combined outcome of ACM or CR
This represented a markedly higher risk compared to either high score alone
The combination of both scores identified the highest-risk subgroup among geriatric inpatients
Results
The H2FPEF score correlated with comorbidity burden and functional disability, but not with cognitive impairment.
H2FPEF score correlated with CCI (β = 0.27, p < 0.01)
H2FPEF score correlated with functional disability as measured by lower Instrumental Activities of Daily Living (IADL) score (β = -0.17, p = 0.003)
No significant correlation was found between H2FPEF score and cognitive impairment
What This Means
This research studied whether a scoring tool called the H2FPEF score — designed to estimate the likelihood of a specific type of heart failure called HFpEF (heart failure with preserved ejection fraction) — could predict bad health outcomes in elderly patients receiving rehabilitation care in a hospital. The study followed 302 patients with a median age of 83 years, tracking whether they died or were rehospitalized for heart-related reasons within one year. It also examined whether a separate measure of overall illness burden, called the Charlson Comorbidity Index (CCI), provided additional or overlapping information.
The study found that both a high H2FPEF score and a high CCI each independently predicted worse outcomes — specifically, nearly a threefold increase in the risk of death or cardiovascular rehospitalization within one year. Importantly, these two scores provided separate, non-overlapping information: having one high score did not cancel out or duplicate the predictive value of the other. Patients who scored high on both measures faced the greatest risk, with more than four times the likelihood of a bad outcome compared to lower-risk patients. About one in four of the elderly rehabilitation patients had a high H2FPEF score, suggesting HFpEF may be underrecognized in this population.
This research suggests that routinely assessing both the H2FPEF score and overall comorbidity burden in elderly rehabilitation patients could help clinicians identify those at highest cardiovascular risk, potentially guiding closer monitoring or more targeted care. The findings highlight that HFpEF risk stratification tools developed in other settings may also be meaningful in the complex, high-comorbidity context of geriatric care.
Dayer N, Auberson D, Lu H, Costa E, Krief H, Nguyen S, et al.. (2026). H2FPEF Score and Charlson Comorbidity Index as Independent Predictors of Cardiovascular Outcomes in Elderly Patients Undergoing Geriatric Rehabilitation.. Clinical cardiology. https://doi.org/10.1002/clc.70496