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The relationship between left ventricular ejection fraction and mortality in patients with acute heart failure: insights from the ASCEND‐HF T rial
Author(s) -
Toma Mustafa,
Ezekowitz Justin A.,
Bakal Jeffrey A.,
O'Connor Christopher M.,
Hernandez Adrian F.,
Sardar Muhammad Rizwan,
Zolty Ronald,
Massie Barry M.,
Swedberg Karl,
Armstrong Paul W.,
Starling Randall C.
Publication year - 2014
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.19
Subject(s) - ejection fraction , medicine , hazard ratio , nesiritide , heart failure , acute decompensated heart failure , cardiology , confidence interval , proportional hazards model , natriuretic peptide
Aim Acute decompensated heart failure (ADHF) is associated with significant morbidity and mortality but the relationship between LVEF and outcomes is unclear. We explored the association between LVEF and 30 and 180 day mortality in 7007 ADHF patients enrolled in the Acute Studies of Nesiritide in Decompensated Heart Failure (ASCEND‐HF) trial. Methods and results We explored the association between LVEF and 30 and 180 day mortality in 7007 ADHF patients enrolled in the Acute Studies of Nesiritide in Decompensated Heart Failure (ASCEND‐HF) trial. LVEF was analysed both as a continuous variable and according to three categories: < 40% (LowEF), 40–50% [intermediate EF (IntEF)], and > 50% [preserved ejection fraction (PresEF)]. Of the patients in the trial, 4474 (78.7%) had LowEF, 674 (11.9%) had IntEF, and 539 (9.5%) had PresEF. The unadjusted 30 and 180 day mortality was similar for LowEF (3.7%, 12.3%), IntEF (3.4%, 13.1%), and PresEF (4.3%, 14.1%), respectively ( P > 0.05). After multivariable adjustment, the hazard ratio (HR) for 180 day mortality remained similar for the LowEF [HR 0.96, 95% confidence interval (CI) 0.75–1.24; P = 0.77] and IntEF (0.91, 95% CI 0.66–1.3; P = 0.58) compared to PresEF patients. By contrast, when LVEF was evaluated as a continuous measure, it exhibited a U‐shaped pattern with mortality. After matching for age and sex, the mortality risk attributed to LVEF was attenuated, as the LVEF increased as a continuous variable over 35%. However, in patients with EF < 35%, the mortality risk continue to increase as the LVEF declined. Conclusions Among patients with ADHF, the unadjusted mortality rates are similar across LVEF strata. However, after accounting for key patient variables, the mortality risk increases as EF falls below 35%. These data will be useful in planning future studies of ADHF. Clinical Trial Registration www.clinicaltrials.gov identifier: NCT00475852