The relationship between left ventricular ejection fraction and mortality in patients with acute heart failure: Insights from the ASCEND-HF Trial

Mustafa Toma, Justin A. Ezekowitz, Jeffrey A. Bakal, Christopher M. O'Connor, Adrian F. Hernandez, Muhammad Rizwan Sardar, Ronald Zolty, Barry M. Massie, Karl Swedberg, Paul W. Armstrong, Randall C. Starling

Research output: Contribution to journalArticlepeer-review

39 Scopus citations

Abstract

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

Original languageEnglish (US)
Pages (from-to)334-341
Number of pages8
JournalEuropean Journal of Heart Failure
Volume16
Issue number3
DOIs
StatePublished - Mar 2014
Externally publishedYes

Keywords

  • Acute heart failure
  • Clinical trial
  • Ejection fraction
  • Outcomes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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