SCORE2-HF estimates future heart failure risk

SCORE2-HF accurately estimated 10-year and 30-year heart failure risk in European adults without prior cardiovascular disease.
*Prediction model derivation and external validation; Level 1 (OCEBM).

Citation

SCORE2-HF Writing Group and European Society of Cardiology Cardiovascular Risk Collaboration. Prediction of incident heart failure in individuals without prior cardiovascular disease: the SCORE2-HF risk model. European Heart Journal. 2026;47:4758-4772. doi:10.1093/eurheartj/ehag154

Background

Heart failure is common, costly, and often preventable. Existing European cardiovascular risk tools do not estimate future heart failure, limiting targeted prevention.

Patients

European adults older than 40 years without prior cardiovascular disease or heart failure. People with prior disease were excluded.

Intervention

Development, recalibration, and validation of SCORE2-HF using routine measures: age, smoking, blood pressure, blood pressure treatment, body mass index, kidney filtration estimate, and type 2 diabetes details.

Control

Performance was compared with an existing American heart failure prediction tool in validation cohorts.

Outcome

First fatal or non-fatal heart failure; model discrimination assessed by C-index (0 to 1; higher is better).

Follow-up Period

Median 13.4 years in model development; validation follow-up varied by cohort.

Results

Data set Participants Heart failure events C-index
Development cohorts 611,778 21,818 0.754 (95% CI 0.750 to 0.758)
England validation 1,227,276 33,946 0.827 (95% CI 0.825 to 0.829)
Norway validation 33,434 2,054 0.839 (95% CI 0.827 to 0.850)
Estonia validation 76,114 841 0.874 (95% CI 0.863 to 0.884)

C-index: how well the model separates people who do and do not develop heart failure.

For 70-year-olds in low-risk regions, estimated 10-year risk ranged from 8% to 24% in men and 6% to 20% in women, depending on risk factors. In very-high-risk regions with four adverse risk factors, risk reached 59%.

Limitations

Most development data came from lower-risk cohorts, especially the United Kingdom. Hospital records may miss heart failure managed only in outpatient care. Calibration slightly overestimated risk under age 70. Some relevant factors, such as family history, social deprivation, activity level, and breathing disorders, were not consistently available.

Funding

Public/charity funding; one author reported AstraZeneca/Novo Nordisk grants.

Clinical Application

Use SCORE2-HF for European adults over 40 without prior cardiovascular disease to guide heart failure prevention discussions and risk-factor treatment.