Background: Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome with substantial early morbidity and mortality. The BREATH2 score was recently developed as an echocardiography-independent screening tool for HFpEF. However, its prognostic significance has not been investigated. This study aimed to evaluate the association between the BREATH2 score and 1-year all-cause mortality in patients with established HFpEF.

Methods: A total of 213 patients with HFpEF were retrospectively analyzed. The primary endpoint was 1-year all-cause mortality. Discriminative performance of the BREATH2, H2FPEF, and HFA-PEFF scores was assessed using receiver operating characteristic analysis. Multiple logistic regression was performed to identify independent predictors of mortality. Kaplan–Meier survival analysis was conducted using a prespecified BREATH2 cut-off (≥6).

Results: During 12-month follow-up, 32 patients (15.0%) died. The BREATH2 score was significantly higher among non-survivors (P = .001). Receiver operating characteristic curve analysis demonstrated that BREATH2 had the highest discriminative ability for 1-year mortality (area under the curve [AUC] = 0.683, P < .001, 95% CI: 0.616-0.745), outperforming H2FPEF (AUC = 0.554, P = .324) and HFA-PEFF (AUC = 0.593, P < .001). In multiple analyses adjusting for age, creatinine, and N-terminal pro-B-type natriuretic peptide,
BREATH2 remained independently associated with mortality (odds ratio = 1.658 per 1-point increase, P = .021, 95% CI: 1.078-2.551). Patients with BREATH2 ≥6 had significantly lower survival compared with those with lower scores(log-rank, P = .013).

Conclusion: The BREATH2 score independently predicts 1-year mortality in patients with HFpEF. Beyond its diagnostic role, BREATH2 may serve as a practical early risk stratification tool at initial clinical presentation.