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.

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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