Log in to MyACC
Ejection Fraction Change in Heart Failure
Study Questions:
What is the incidence, and what are the predictors and associations with outcomes of changes in ejection fraction (EF) in heart failure (HF) patients?
Methods:
The investigators enrolled patients with ≥2 consecutive EF assessments. Patients with ≥2 EF measurements and included in the Swedish Heart Failure Registry were categorized as HF with preserved EF (HFpEF) (EF ≥50%), HF with midrange EF (HFmrEF) (EF 40-49%), or HF with reduced EF (HFrEF) (EF <40%). Changes among categories were recorded, and associations among EF changes, predictors, and all-cause mortality and/or HF hospitalizations were analyzed using logistic and Cox regressions.
Results:
Of 4,942 patients at baseline, 18% had HFpEF, 19% had HFmrEF, and 63% had HFrEF. During follow-up, 21% and 18% of HFpEF patients transitioned to HFmrEF and HFrEF, respectively; 37% and 25% of HFmrEF patients transitioned to HFrEF and HFpEF, respectively; and 16% and 10% of HFrEF patients transitioned to HFmrEF and HFpEF, respectively. Predictors of increased EF included use of angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers, female sex, cases of less severe HF, and comorbidities. Predictors of decreased EF included diabetes, ischemic heart disease, and cases of more severe HF. Increased EF was associated with a lower risk (hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.55-0.69) and decreased EF with a higher risk (HR, 1.15; 95% CI, 1.01-1.30) of mortality and/or HF hospitalizations. Prognostic implications were most evident for transitions to and from HFrEF.
Conclusions:
The authors concluded that EF change was associated with a wide range of important clinical, treatment, and organizational factors as well as with outcomes, particularly transitions to and from HFrEF.
Perspective:
This study of unselected patients with HF reports that EF change over time was a common occurrence across all EF groups with EF increase over time occurring in one-fourth of patients with HFrEF and HFmrEF, and a decrease occurring in more than one third of those with HFpEF and HFmrEF. Furthermore, increased EF was associated with a more favorable outcome, whereas decreased EF portended a poor prognosis with differences most evident for transitions to and from HFrEF. Additional studies are indicated to better understand the mechanisms behind EF change, particularly for EF deterioration from HFpEF and the use of global longitudinal strain and global circumferential strain parameters over time, particularly relating to prognostic accuracy in chronic HF.
Clinical Topics: Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Acute Heart Failure
Keywords: Angiotensin Receptor Antagonists, Angiotensin-Converting Enzyme Inhibitors, Comorbidity, Diabetes Mellitus, Diagnostic Imaging, Heart Failure, Myocardial Ischemia, Prognosis, Secondary Prevention, Stroke Volume
< Back to Listings
