Applied to 278 patients hospitalized for acutely decompensated HFpEF (median age 75, 51.4% male), the AHA's PREVENT equations — designed for primary CVD prevention — independently predicted major adverse cardiovascular events (MACE: all-cause death, HF hospitalization, stroke). Over a median 1,050-day follow-up, MACE occurred in 45% of patients. Patients in the lowest PREVENT risk quartile had significantly better event-free survival (log-rank p<0.001), and PREVENT added incremental prognostic value beyond NT-proBNP (C-index improvement, p=0.009), performing comparably to the established MAGGIC heart failure score (AUC 0.676 vs. 0.639).
HFpEF remains one of cardiology's most prognostically challenging diagnoses, accounting for roughly half of all heart failure cases yet lacking validated disease-modifying therapies. The finding that a primary-prevention risk calculator — incorporating traditional factors like blood pressure, lipids, kidney function, and diabetes — retains predictive signal in this secondary-care population is clinically intuitive but practically significant: it suggests clinicians need not rely solely on HF-specific biomarkers when stratifying risk. However, the C-index of 0.626 and AUC of 0.676 indicate only moderate discrimination, and the single-center Japanese cohort of 278 patients limits generalizability across ethnically diverse populations. The median age of 75 also reflects a high-risk, post-hospitalization phenotype unlikely to represent broader HFpEF outpatients. As a preprint posted on medRxiv and not yet peer-reviewed, these findings should be considered preliminary. Confirmatory multicenter trials with larger, ethnically diverse samples are needed before PREVENT scores enter routine HFpEF risk stratification.
