{"id":"46003","type":"article","url":"https://hartvaat.nl/2026/05/04/angina-toevoegen-aan-de-h2fpef-score-verbetert-hfpef-diagnose-bij-vrouwen-geen-w/","title":"Angina toevoegen aan de H2FPEF-score verbetert HFpEF-diagnose bij vrouwen — geen winst bij mannen","title_en":"","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Open Heart","doi":"http://openheart.bmj.com/cgi/content/short/13/1/e004054?rss=1","source_url":"https://doi.org/http://openheart.bmj.com/cgi/content/short/13/1/e004054?rss=1","authors":["Qu","K.","Onland-Moret","N. C.","de Vos","A.","van Ommen","A. M. L. N.","van Mourik","Y.","van Riet","E. E.","Boonman - de Winter","L.","Handoko","M. L.","Cramer","M. J.","Teske","A. J.","Menken","R.","Rutten","F.","den Ruijter","H. M.","Dal Canto","E."],"significance":6,"published":"2026-07-10","source_date":"2026-05-04","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/","https://hartvaat.nl/kennis/vasculair/pulmonale-hypertensie/"],"congress":"","summary_en":"Diagnostic study in 515 patients from the UHFO-DM cohort with suspected HFpEF, plus 751 patients from three additional cohorts (UHFO-COPD, STRETCH, TREE). Symptoms, including angina by WHO questionnaire, were collected in standardised fashion; HFpEF was adjudicated by expert panel. HFpEF prevalence 24% in UHFO-DM. The H2FPEF score had an overall AUC of 0.72 (0.69 in women, 0.74 in men). Angina was independently associated with HFpEF in women (OR 3.96; 95% CI 1.72-9.11; p=0.001) but not in men (OR 1.90; p=0.10). Adding one point for angina to H2FPEF in women improved AUC from 0.69 to 0.71 (DeLong p=0.030), sensitivity from 0.53 to 0.60, and NPV from 0.80 to 0.82, with continuous net reclassification improvement 0.449. No gain in men. A simple sex-specific modification of H2FPEF — for women only — therefore improves diagnostic precision for HFpEF.","created":"2026-07-03T20:27:04Z","updated":"2026-07-04T19:09:38Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Diagnostische studie bij 515 patiënten uit het UHFO-DM-cohort met verdenking HFpEF, plus 751 patiënten uit drie aanvullende cohorten (UHFO-COPD, STRETCH, TREE). Symptomen, inclusief angina via WHO-vragenlijst, werden gestandaardiseerd verzameld; HFpEF werd door een expert-panel geadjudiceerd. HFpEF-prevalentie 24% in UHFO-DM. De H2FPEF-score had overall AUC 0,72 (0,69 vrouwen, 0,74 mannen). Angina was bij vrouwen onafhankelijk geassocieerd met HFpEF (OR 3,96; 95%-BI 1,72-9,11; p=0,001) maar niet bij mannen (OR 1,90; p=0,10). Eén punt toevoegen voor angina aan H2FPEF bij vrouwen verbeterde de AUC van 0,69 naar 0,71 (DeLong p=0,030), sensitiviteit van 0,53 naar 0,60 en NPV van 0,80 naar 0,82, met continue netto-reclassificatie-verbetering 0,449. Bij mannen geen winst. Een eenvoudige sekse-specifieke aanpassing van H2FPEF — alleen voor vrouwen — verbetert dus de diagnostische precisie voor HFpEF.","abstract_original":"<sec><st>Background and aims</st>\n<p>The Heavy, Hypertensive, Atrial fibrillation, Pulmonary hypertension, Elder, Filling pressure (H<SUB>2</SUB>FPEF) score is a widely used diagnostic tool for heart failure with preserved ejection fraction (HFpEF). Angina symptoms are common in patients with HFpEF but are not included in the score. We aimed to determine whether incorporating angina into the H<SUB>2</SUB>FPEF score improves its diagnostic performance sex-specifically, given the well-known sex differences in both HFpEF and angina presentation.</p>\n</sec>\n<sec><st>Methods</st>\n<p>We included 515 individuals from the UHFO-DM cohort with suspected HFpEF. Participants underwent standardised symptom collection, including angina using WHO questionnaires, and expert-panel adjudication of HFpEF. Following evaluation of H<SUB>2</SUB>FPEF, we assessed the association of angina with HFpEF independent of H<SUB>2</SUB>FPEF using logistic regression. By adding angina to H<SUB>2</SUB>FPEF, we developed a modified algorithm and evaluated it by the area under the receiver operating characteristic curve (AUC), calibration, reclassification and decision curve analysis. All analyses were stratified by sex. We also included another 751 individuals with suspected HFpEF from a Combination cohort of UHFO-COPD (n=136), STRETCH (n=331) and TREE (n=284) for regression analysis.</p>\n</sec>\n<sec><st>Results</st>\n<p>In the UHFO-DM cohort, HFpEF prevalence was 24%. Overall H<SUB>2</SUB>FPEF discrimination (AUC) was 0.72, with 0.69 in women and 0.74 in men. Angina was independently associated with HFpEF in women (OR 3.96, 95% CI 1.72 to 9.11, p=0.001) but not in men (1.90, 0.88 to 4.10, 0.102). Adding one point for angina in a modified H<SUB>2</SUB>FPEF score in women improved AUC from 0.69 to 0.71 (DeLong p=0.030), increased sensitivity (0.53 to 0.60) and negative predictive value (0.80 to 0.82) and yielded a continuous net reclassification improvement of 0.449, with preserved calibration and higher net clinical benefit on decision curves. No performance gain was observed with the same modification in men. In the Combination cohort, angina was also independently associated with HFpEF only in women (women, 2.13, 1.14 to 3.97, 0.018; men, 0.85, 0.44 to 1.66, 0.638).</p>\n</sec>\n<sec><st>Conclusions</st>\n<p>In women with suspected HFpEF, the presence of angina provides diagnostic information independent of H<SUB>2</SUB>FPEF to uncover HFpEF. A simple sex-specific modification of H<SUB>2</SUB>FPEF, adding one point for angina in women, may slightly improve discrimination and rule-out performance in women.</p>\n</sec>"}