Likelihood and Outcomes of Heart Failure with Non-Reduced Ejection Fraction among Patients with Negative Cardiac Amyloidosis Screening.

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Background Heart failure with non-reduced ejection fraction (HFnrEF) is a clinically heterogeneous condition leading to diagnostic challenges. Identifying populations with a higher likelihood of HFnrEF may increase diagnostic efficiency and translate into earlier appropriate care. Methods We conducted a retrospective cohort analysis of adult patients with an LVEF ≥ 40% and negative CA screening (SPECT-pyrophosphate imaging and/or via a dedicated CA clinic) at our center from January 2018 to August 2023. H2FPEF and HFA-PEFF scores were calculated for each patient. Patients were subsequently categorized as high (both H2FPEF ≥ 6 and HFA-PEFF ≥ 5), intermediate (either H2FPEF ≥ 6 or HFA-PEFF ≥ 5), or otherwise indeterminate probability of HFnrEF. Baseline medical management and clinical outcomes at 1 year were recorded. Results Of the 302 patients included (43% women, mean age 74 years, BMI 28.7 ± 6.8 kg/m 2 , NT-pro-BNP 4,640 ± 7,877 ng/L), 25% were classified as high and 42% as intermediate HFnrEF probability. However, only half had a documented clinical diagnosis of HFnrEF. Among patients with high or intermediate probability, 6% were treated with SGLT2i, 29% with MRA and 43% with ACEI/ARB. Heart failure hospitalizations occurred in 16% and mortality was 14% at 1 year in this group. Conclusion Two-thirds of patients with negative CA screening had intermediate or high probability of HFnrEF based on H2FPEF and HFA-PEFF scores, which was also associated with a higher rate of adverse events. Using these scores in combination to prioritize patient referrals to dedicated HFnrEF clinics may lead to improved treatment and outcomes.

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