ArticleNetherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation2025
Sex-specific performance of clinical diagnostic algorithms for HFpEF across two independent cohorts.
Article in Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Heart failure with preserved ejection fraction in women: a sex-specific clinical review.The Korean journal of internal medicine · 2026Review
- Advancing cardiovascular care-key insights from the Netherlands Heart Journal 2025.Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation · 2026Article
- Bridging the Gap: Time to Integrate Sex- and Gender-Specific Insights into Research and Practice.Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation · 2025Article
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9 authors.
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Abstract
backgroundDiagnosing heart failure with preserved ejection fraction (HFpEF) remains challenging. While diagnostic algorithms support clinical evaluation, their performance across sexes is understudied, despite HFpEF being more prevalent in females, which may result in sex-specific underdiagnosis. PURPOSE: To assess the diagnostic accuracy of three HFpEF algorithms-HFA-PEFF, H
methodsTwo prospective cohorts with unexplained dyspnoea were analysed. The Amsterdam cohort (2014-2020; n = 135) had HFpEF confirmed or excluded via (exercise) right heart catheterization (RHC). The Maastricht cohort (2015-2021; n = 659) had HFpEF confirmed or excluded based on expert consensus with utilisation of HFpEF scores, and RHC when needed. Sex-specific diagnostic performance of three HFpEF algorithms was assessed using ROC curves, AUC, and a panel of metrics with cut-offs determined by the rule-in/rule-out strategies.
resultsHFpEF prevalence was high in both cohorts (84.4% and 82.5%), with a female majority (69.6% and 66.5%). Across all algorithms, males consistently showed lower AUC values than females, although differences were not statistically significant. The highest diagnostic performance within the Amsterdam cohort was observed with H
conclusionsHFpEF diagnostic algorithms may perform better in females than males in referral outpatient settings. Inconsistent performance of diagnostic algorithms between different sexes warrants further optimisation to diagnose HFpEF.
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