Ejection fraction and mortality: a nationwide register‐based cohort study of 499 153 women and men

Stewart, S., Playford, D., Scalia, G. M., Currie, P., Celermajer, D. S., Prior, D., Codde, J. and Strange, G. (2021) Ejection fraction and mortality: a nationwide register‐based cohort study of 499 153 women and men. European Journal of Heart Failure, 23(3), pp. 406-416. (doi: 10.1002/ejhf.2047) (PMID:33150657)

Abstract

Aims: We investigated the sex-based risk of mortality across the spectrum of left ventricular ejection fraction (LVEF) in a large cohort of patients in Australia. Methods and results: Quantified levels of LVEF from 237 046 women (48.1%) and 256 109 men undergoing first-time, routine echocardiography (2000–2019) were linked to 119 232 deaths (median 5.6 years of follow-up). Overall, 17.6% of men vs. 8.3% of women had an LVEF <50%. An LVEF <40% was associated with the highest crude cardiovascular-related and all-cause mortality at 5 years (∼20–30% and ∼ 40–50%, respectively). Thereafter, actual cardiovascular-related and all-cause mortality at 5 years in both sexes steeply improved to a nadir LVEF of 65.0–69.9% (reference group). Below this LVEF level, the adjusted hazard ratio (HR) for cardiovascular-related mortality for a LVEF of 55.0–59.9% was 1.36 [95% confidence interval (CI) 1.16–1.59; P < 0.001] in women and 1.21 (95% CI 1.05–1.39; P = 0.008) in men. In women, an LVEF of 60.0–64.9% was also associated with a HR 1.33 (95% CI 1.16–1.52; P < 0.001) for cardiovascular-related mortality. These associations were most striking in women and men aged <65 years and were replicated in those with suspected heart failure (32 403 cases aged 65.2 ± 16.1 years, 57.0% women). For pre-existing heart failure (33 738 cases aged 67.6 ± 16.9 years, 46.5% women), the specific threshold of increased mortality was at and below 50.0–54.9%. Conclusions: Among patients investigated for suspected or established cardiovascular disease, we found clinically relevant sex-based differences in the distribution and mortality associated with an LVEF <65.0–69.9%. Specifically, they suggest a greater risk of mortality at higher LVEF levels among women.

• Item Type: Articles
• Additional Information: This work has been partially supported by Novartis Pharma AG. S.S. is supported by the NHMRC of Australia (GNT1135894).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Stewart, Professor Simon
• Authors: Stewart, S., Playford, D., Scalia, G. M., Currie, P., Celermajer, D. S., Prior, D., Codde, J., and Strange, G.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: European Journal of Heart Failure
• Publisher: Wiley
• ISSN: 1388-9842
• ISSN (Online): 1879-0844
• Published Online: 04 November 2020
• Copyright Holders: Copyright © 2020 The Authors
• First Published: First published in European Journal of Heart Failure 23(3): 406-416
• Publisher Policy: Reproduced under a Creative Commons License