Prognostic Utility of the HFpEF-ABA Score for HFpEF Patients: Insights From the TOPCAT Trial.

BACKGROUND The HFpEF-ABA score, incorporating age, body mass index (BMI), and atrial fibrillation (AF), has demonstrated utility in patients with heart failure with preserved ejection fraction (HFpEF). OBJECTIVES This study evaluated the prognostic performance of the HFpEF-ABA score within the Americas and Russia/Georgia cohorts of the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist) trial, examining its association with clinical outcomes across these distinct regions. METHODS Cox proportional hazards and competing risk regression analyses assessed associations between HFpEF-ABA probabilities and clinical outcomes. RESULTS Among the Americas cohort (n = 1,726), 72.7% exhibited an HFpEF-ABA probability ≥75%. Elevated HFpEF-ABA probabilities were modestly associated with an increased risk of HF hospitalization HR per 10% increase: 1.07; 95% CI: 1.00-1.14) and any hospitalization (HR per 10% increase: 1.04; 95% CI: 1.00-1.08), without significant associations with mortality or major cardiovascular events. In the Russia/Georgia cohort (n = 1,674), 39.8% had probability ≥75%. Higher HFpEF-ABA probabilities were significantly associated with increased risks of all-cause mortality (HR: 1.67; 95% CI: 1.16-2.41), heart failure hospitalization (HR: 1.98; 95% CI: 1.04-3.78), any hospitalization (HR: 1.75; 95% CI: 1.43-2.14,) and stroke (HR: 2.81; 95% CI: 1.44-5.5). A linear trend of escalating adverse outcome risks corresponded with increasing HFpEF-ABA probabilities in the Russia/Georgia cohort, excluding stroke. CONCLUSIONS Our study demonstrates substantial regional heterogeneity in the prognostic utility of the HFpEF-ABA score among patients with HFpEF enrolled in the TOPCAT trial. The score exhibited strong associations with adverse outcomes in the Russia/Georgia cohort, whereas its prognostic discrimination was attenuated in the Americas cohort. (Aldosterone Antagonist Therapy for Adults With Heart Failure and Preserved Systolic Function [TOPCAT]; NCT00094302).

• Publication year

  2026

• Venue

  JACC: Advances

• Publication date

  2026-02-24

• Fields of study

  Medicine

• Identifiers
  DOI 10.1016/j.jacadv.2026.102632PMID 41740242PMCID PMC12955119
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar

• No claims are published for this paper.

• No concepts are published for this paper.

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