HFpEF-ABA Score for the Diagnosis and Prognosis of HFpEF in Outpatients With Type 2 Diabetes

Abstract

Background Heart failure (HF) with preserved ejection fraction (HFpEF) is highly prevalent among adults with type 2 diabetes (T2D) but often remains undiagnosed. The HFpEF-ABA score (based on age, body-mass index and atrial fibrillation) has demonstrated excellent diagnosis performance in patients with unexplained dyspnea but lacks validation for opportunistic screening of HFpEF. Objectives We aimed to evaluate the diagnostic and prognostic utility of the HFpEF-ABA score in outpatients with T2D. Methods We analyzed 1,125 outpatients with T2D from the prospective, multicenter DIABET-IC cohort. HFpEF diagnosis was based on the European Society of Cardiology guidelines criteria and confirmed by a cardiologist. We evaluated the diagnostic performance of HFpEF-ABA score and its association with 3-year all-cause death, HF hospitalization, and their composite. Results HFpEF was confirmed in 190 participants (16.9%). The HFpEF-ABA score yielded an area under the receiver operating characteristic curve of 0.75 (95% CI: 0.71-0.79). Over 3 years, 61 deaths and 23 HF hospitalizations occurred. Per 10-percentage-point increase in HFpEF probability, the risk increased for all-cause death (HR: 1.34; 95% CI: 1.17-1.54), HF hospitalization (HR: 1.16; 95% CI: 0.94-1.43), and the composite endpoint (HR: 1.28; 95% CI: 1.14-1.44). Scores ≥75% identified patients at higher risk of death (HR: 2.40; 95% CI: 1.45-3.97), HF hospitalization (HR: 2.51; 95% CI: 1.10-5.72), and the composite (HR: 2.41; 95% CI: 1.55-3.73). Conclusions In ambulatory adults with T2D, the HFpEF-ABA score showed moderate diagnostic discrimination for HFpEF and was associated with adverse clinical outcomes at follow-up.