NCDR Study Shows Significant Inter-Hospital Variability in LVEF Assessment

While the assessment of left ventricular ejection fraction (LVEF) has improved significantly over time in patients with acute myocardial infarction (MI), significant inter-hospital variability exists, according to a recent study published in Circulation.


The study, which examined 77,982 non-ST-elevation myocardial infarction (NSTEMI) patients and 50,863 STEMI patients enrolled in the NCDR® ACTION Registry® – GWTG™, showed overall improvement in LVEF assessment, with higher rates among STEMI patients than NSTEMI patients (95.1 percent versus 91.6 percent; P<0.001). Excluding patients with prior heart failure did not alter these observations, the authors noted. However, despite the overall increase in LFEF assessment, there was major variation at the hospital level. According to the study, although patient age and clinical comorbidities contributed to individual decision making for LVEF assessment, hospitals with lower composite AMI care quality were less likely to perform LVEF assessments (odds ratio for failure to assess LVEF, 1.09; 95 percent confidence interval, 1.05–1.13 per 10 percent decrease in defect-free care). Failure to assess LVEF was also associated with lower rates of guideline-recommended therapy use at discharge.

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Moving forward, the study authors suggest that patients who tend not to undergo in-hospital LVEF assessment – in this case, those that are older and more likely to have clinical comorbidities – represent targets for future quality improvement efforts.

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