Patients with heart failure and missing ejection fraction had similar 3-year adjusted mortality to those with reduced EF (HR 1.03; 95% CI 0.95-1.12) and greater mortality than those with preserved EF.
Meta-Analysis (n=30,445)
Yes
Is missing left ventricular ejection fraction associated with worse outcomes in patients with heart failure?
Missing LVEF measurement is common in heart failure patients and is associated with a high-risk comorbidity profile and mortality rates similar to those with reduced EF.
Effect estimate: HR 1.03 (vs HF-REF); HR 0.78 (vs HF-PEF) (95% CI 0.95-1.12 (vs HF-REF); 0.71-0.86 (vs HF-PEF))
AIMS: Treatment of patients with heart failure (HF) relies on measurement of LVEF. However, the extent to which EF is recorded varies markedly. We sought to characterize the patient group that is missing a measure of EF, and to explore the association between missing EF and outcome. METHODS AND RESULTS: Individual data on 30 445 patients from 28 observational studies in the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) project were used to compare the prevalence of co-morbidities and outcome across three groups of HF patients: those with missing EF (HF-mEF), reduced EF (HF-REF), and preserved EF (HF-PEF). A total of 29% had HF-mEF, 52% HF-REF, and 19% HF-PEF. Compared with patients in whom EF was known, patients with HF-mEF were older, had a greater prevalence of COPD and previous stroke, and were smokers. Patients with HF-mEF were less likely to receive evidence-based treatment than those with HF-REF. Adjusted mortality in HF-mEF was similar to that in HF-REF and greater than that in HF-PEF at 3 years HF-REF, hazard ratio (HR) 1.03, 95% confidence interval (CI) 0.95-1.12); HF-PEF, HR 0.78, 95% CI 0.71-0.86. CONCLUSION: Missing EF is common. The short- and long-term outcome of patients with HF-mEF is poor and they exhibit different co-morbidity profiles and treatment patterns compared with patients with known EF. HF patients with missing EF represent a high risk group.
Poppe et al. (Wed,) conducted a meta-analysis in Heart failure (n=30,445). Missing LVEF (HF-mEF) vs. Known LVEF (HF-REF and HF-PEF) was evaluated on Adjusted mortality at 3 years (HR 1.03 (vs HF-REF); HR 0.78 (vs HF-PEF), 95% CI 0.95-1.12 (vs HF-REF); 0.71-0.86 (vs HF-PEF)). Patients with heart failure and missing ejection fraction had similar 3-year adjusted mortality to those with reduced EF (HR 1.03; 95% CI 0.95-1.12) and greater mortality than those with preserved EF.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: