HEFESTOS Score Effective for Predicting Outcomes Post-HF Decompensation

Person with chest pain
3d rendered illustration of a man with chest pain.
Researchers aimed to develop and validate a risk score to predict hospitalization and mortality in a primary care setting for patients with heart failure decompensation.

The HEFESTOS scoring system is useful for stratifying risk for hospitalization or mortality in patients with heart failure (HF) decompensation, according to a study published in ESC Heart Failure.

For the international HEFESTOS study, researchers enrolled a derivation cohort of patients with HF (mean age 82.2±8.03 years; 56.3% women) from 14 Barcelona health care centers and a primary care cohort of individuals in primary care (mean age 79.3±10.3 years; 47.6% women) from 9 other European countries.

The respective rates of HF with preserved ejection fraction in the derivation vs validation cohorts were 72.1% and 58.5%, respectively; the respective rates of mortality or hospitalization during the first 30 days following a decompensation episode were 30.5% and 26.0% (P =.225). The correlation between outcome and categorical variables was assessed using a chi-squared test, and differences between continuous variables were assessed using a Student’s t-test. A risk score was developed using multivariable logistic regression models.

Several predictors of risk were identified: worsening dyspnea (odds ratio [OR], 2.5; P =.001); paroxysmal nocturnal dyspnea (OR, 2.25; P =.01); orthopnea (OR, 2.16; P =.01); New York Heart Association functional class III or IV (OR, 2.11; P =.001); crackles (OR, 2.35; P =.01); heart rate over 100 bpm (OR, 2.72; P =.002); oxygen saturation less than or equal to 90% (OR, 4.98; P <.001); and previous HF­-related hospitalization (OR, 2.45; P <.001).

The derivation cohort had an area under the curve of 0.807 (95% CI, 0.770-0.845) compared with 0.73 (95% CI, 0.660-0.808) in the validation cohort (P =.08). There were 3 risk groups with respect to probability of hospitalization or mortality within 30 days of decompensation episode: low (<5%); medium (5-20%); and high (>20%). Low risk corresponded to scores less than or equal to 3; medium 4-7; and high greater than or equal to 8.

Within the derivation cohort, the cumulative outcome incidences for the low-, medium-, and high-risk groups were 2.7%, 12.8%, and 46.22%, respectively. For the validation cohort, they were 9.09%, 12.9%, and 39.68%, respectively.

Limitations to this study include potentially limited generalizability and difficulty in ensuring consecutive recruitment.

“The HEFESTOS score is a usable tool based on variables easily collected in primary care. It stratifies the risk [for] death or hospitalization in [HF] patients presenting decompensation,” the study authors said.


Verdu-Rotellar JM, Abellana R, Vaillant-Roussel H, et al. Risk stratification in heart failure decompensation in the community: HEFESTOS score. ESC Heart Fail. Published online November 22, 2021. doi:10.1002/ehf2.13707