MedCalcHub stores your favorites, history, and saved calculations locally in your browser using localStorage. This data never leaves your device.
Optional advertising, when enabled, may use third-party cookies or similar technologies. You can accept or reject advertising below.
H2FPEF score for estimating the probability of heart failure with preserved ejection fraction (HFpEF) in patients with unexplained dyspnea (score 0–9).
Clinical decision-support tool for qualified healthcare professionals. Results are not a diagnosis and should not replace professional clinical judgment.
H2FPEF score estimates the probability of HFpEF in patients with unexplained dyspnea: 0–1 (low, ~6% probability), 2–5 (intermediate, ~10–46%), 6–9 (high, ~67–95% probability of HFpEF). The score was derived and validated in patients referred for unexplained exertional dyspnea and includes atrial fibrillation (3 points) as the strongest predictor.
Specialty
CardiologyCategory
CardiologyDifficulty
Basic
Estimated Time
30 seconds
Version
1.0
Last Updated
2026-08-15
Formula
Keywords
Normal Range
0–9 points
Estimates the probability of heart failure with preserved ejection fraction (HFpEF) in patients with unexplained dyspnea, using clinical and echocardiographic features.
The H2FPEF score adds 3 points for atrial fibrillation, 2 points if BMI is over 30 kg/m2, 1 point if age is over 60 years, 1 point for two or more antihypertensive medications, 1 point for E/e' over 9, and 1 point for pulmonary artery systolic pressure over 35 mmHg, for a total of 0-9. Higher scores indicate greater HFpEF probability.
Paroxysmal or persistent atrial fibrillation; Yes contributes 3 points.
BMI in kg/m2; over 30 contributes 2 points.
Age in years; over 60 contributes 1 point.
Two or more antihypertensive medications contributes 1 point.
Septal e' averaged with lateral e'; over 9 contributes 1 point.
PASP over 35 mmHg contributes 1 point.
Score 0–1: low probability of HFpEF (~6%); 2–5: intermediate (~10–46%) — consider further testing such as exercise echocardiography or invasive hemodynamics; 6–9: high probability (~67–95%) — HFpEF is very likely and treatment should be considered.
H2FPEF provides a practical, evidence-based framework for diagnosing HFpEF, reducing reliance on invasive testing while accurately identifying patients likely to benefit from HFpEF therapy.
A 66-year-old woman with persistent atrial fibrillation, BMI 32, taking 3 antihypertensives, has E/e' 11 and PASP 40 mmHg on echocardiography, with unexplained dyspnea.
Inputs:
Expected Result: H2FPEF score 9 — HIGH probability of HFpEF (~95%). HFpEF is very likely; proceed with HFpEF treatment.
It estimates the probability of heart failure with preserved ejection fraction in patients with unexplained exertional dyspnea. Scores of 0-1 indicate low probability (about 6%), 2-5 intermediate probability (about 10-46%), and 6-9 high probability (about 67-95%). It is not a substitute for exercise testing or invasive hemodynamics when results are ambiguous, and it applies only when ejection fraction is preserved.
Atrial fibrillation contributes the most at 3 points, followed by a body mass index over 30 kg/m2 at 2 points. One point each is added for age over 60 years, two or more antihypertensive medications, an E/e' ratio over 9, and a pulmonary artery systolic pressure over 35 mmHg, for a total of 0-9. Higher totals indicate greater probability.
It was developed in patients referred specifically for unexplained exertional dyspnea, so its accuracy in general primary care populations is less clear. The score needs echocardiographic measures, including E/e' and pulmonary artery systolic pressure, that are often unavailable at first assessment. For intermediate scores it does not include the resting or exercise filling pressures that may be needed to confirm the diagnosis.
Disclaimer: This calculator is intended for educational and clinical decision support purposes only. The diagnosis of HFpEF requires clinical judgment and may warrant further testing in intermediate-risk patients.