Natural History of Left Ventricular Ejection Fraction in Patients With Heart Failure

被引:63
作者
Clarke, Christina L. [1 ]
Grunwald, Gary K. [2 ,4 ]
Allen, Larry A. [1 ,4 ]
Baron, Anna E. [2 ,4 ]
Peterson, Pamela N. [1 ,3 ,4 ]
Brand, David W. [1 ]
Magid, David J. [1 ,4 ]
Masoudi, Frederick A. [1 ,4 ]
机构
[1] Kaiser Permanente Colorado Inst Hlth Res, Denver, CO 80231 USA
[2] Denver VA Med Ctr, Denver, CO USA
[3] Denver Hlth Med Ctr, Denver, CO USA
[4] Univ Colorado Anschutz Med Campus, Denver, CO USA
来源
CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES | 2013年 / 6卷 / 06期
基金
美国医疗保健研究与质量局;
关键词
heart failure; outcomes assessment; prognosis; ventricular ejection fraction; ASSOCIATION TASK-FORCE; AMERICAN-COLLEGE; MULTISTATE MODEL; PANEL-DATA; CARVEDILOL; SURVIVAL; DYSFUNCTION; GUIDELINES; METOPROLOL; MORTALITY;
D O I
10.1161/CIRCOUTCOMES.111.000045
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-Patients with heart failure (HF) are typically designated as having reduced or preserved ejection fraction (HFREF, HFPEF) because of the importance of left ventricular ejection fraction (LVEF) on therapeutic decisions and prognosis. Such designations are not necessarily static, yet few data exist to describe the natural history of LVEF over time. Methods and Results-We identified 2413 patients from Kaiser Permanente Colorado with a primary discharge diagnosis of HF between January 1, 2001, and December 31, 2008, who had >= 2 LVEF measurements separated by >= 30 days. We used multi-state Markov modeling to examine transitions among HFREF, HFPEF, and death. We observed a total of 8183 transitions. Women were more likely than men to transition from HFREF to HFPEF (hazard ratio, 1.85; 95% confidence interval, 1.38-2.47). Patients who were adherent to beta-blockers were more likely to transition from HFREF to HFPEF (hazard ratio, 1.53; 95% confidence interval, 1.10-2.13) compared with patients who were nonadherent to beta-blockers, whereas angiotensin-converting enzyme or angiotensin II receptor blocker adherence was not associated with LVEF transitions. Patients who had a previous myocardial infarction were more likely to transition from HFPEF to HFREF (hazard ratio, 1.75; 95% confidence interval, 1.26-2.42). Conclusions-In this cohort of patients with HF, LVEF is a dynamic factor related to sex, coexisting conditions, and drug therapy. These findings have implications for left ventricular systolic function ascertainment in patients with HF and support evidence-based therapy use, especially beta-blockers.
引用
收藏
页码:680 / +
页数:15
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