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

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.