Strange, G., Playford, D., Scalia, G. M., Celermajer, D. S., Prior, D., Codde, J., Chan, Y.‐K., Bulsara, M. K. and Stewart, S. (2021) Change in ejection fraction and long-term mortality in adults referred for echocardiography. European Journal of Heart Failure, 23(4), pp. 555-563. (doi: 10.1002/ejhf.2161) (PMID:33768605)
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Abstract
Aims: We investigated long-term mortality associated with changes in left ventricular ejection fraction (LVEF) in a large, real-world patient cohort. Methods and results: A total of 117 275 adults (63 ± 16 years, 46% women) had LVEF quantified by the same method ≥6 months apart. This included 17 343 cases (66 ± 15 years, 48% women) being initially investigated for heart failure (HF). During 3.3 [interquartile range (IQR) 1.7–6.0] years from first to last echocardiogram, median change in LVEF was −1 (IQR −8 to +5) units from a baseline of 62% (IQR 54–69%). During subsequent 7.6 (IQR 4.3–10.1) years of follow-up, 11 397 (9.7%) and 34 101 (29.1%) cases died from cardiovascular disease and all causes, respectively. Actual 5-year, all-cause mortality increased from 12% to 29% among those with the smallest to the largest decrease in LVEF (from <5 units to >30 units); the adjusted risk of cardiovascular-related mortality increased two- to eightfold beyond a >10-unit decline in LVEF (vs. minimal change; P < 0.001 for all comparisons). Among those initially investigated for HF (32% with initial LVEF <50%), the adjusted hazard ratio for cardiovascular-related mortality ranged from 0.35 [95% confidence interval (CI) 0.28–0.49] to 4.21 (95% CI 3.30–5.22) for a >30-unit increase to >30-unit decline in LVEF (vs. minimal change; P < 0.001 for both comparisons). A distinctive, bi-directional plateau of improved vs. worsening mortality was evident around a final LVEF of 50% to 55%. Conclusions: These data, derived from a large, heterogeneous cohort of adults being followed up with echocardiography, suggest that modest LVEF changes (particularly around an LVEF of 50–55%) may be of clinical significance.
Item Type: | Articles |
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Additional Information: | This work was partially supported by Novartis Pharmaceuticals. S.S. is supported by the NHMRC of Australia (GNT1135894). |
Status: | Published |
Refereed: | Yes |
Glasgow Author(s) Enlighten ID: | Stewart, Professor Simon |
Authors: | Strange, G., Playford, D., Scalia, G. M., Celermajer, D. S., Prior, D., Codde, J., Chan, Y.‐K., Bulsara, M. K., and Stewart, S. |
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: | 25 March 2021 |
Copyright Holders: | Copyright © 2021 The Authors |
First Published: | First published in European Journal of Heart Failure 23(4): 555-563 |
Publisher Policy: | Reproduced under a Creative Commons License |
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