Prognostic Utility of HEFESTOS Score and Complementary Lung Ultrasound for Heart Failure Decompensation in Primary Care Outpatients: A Prospective Cohort Study

Heart failure (HF) is a major contributor to morbidity, mortality, and healthcare costs, particularly among older adults. Effective outpatient risk stratification remains a clinical challenge, especially following hospital discharge or episodes of acute decompensation. Although both lung ultrasound (LUS) and the HEFESTOS score have shown individual prognostic value, their combined use in primary care settings has not been extensively explored. This prospective cohort study included 107 patients with confirmed HF followed at a primary care center in southern Catalonia. At baseline, all patients underwent LUS and HEFESTOS assessment. The primary outcome was HF decompensation, defined as worsening symptoms requiring medical attention, emergency care, hospitalization, or death. Over a mean follow-up of 72 days, 25 patients (23.3%) experienced decompensation. In multivariate analysis, only the HEFESTOS score was independently associated with decompensation. LUS and HEFESTOS showed moderate agreement (Kappa = 0.456), and LUS demonstrated moderate discriminative capacity (AUC = 0.677) with high sensitivity (81.7%) and positive predictive value (81.7%). These findings support the routine use of the HEFESTOS score in primary care and suggest that LUS may serve as a complementary tool, particularly for identifying subclinical pulmonary congestion. Their combined use could enhance outpatient risk stratification and guide individualized follow-up strategies in HF management.