Left Ventricular Ejection Fraction Assessment Among Patients With Acute Myocardial Infarction and Its Association With Hospital Quality of Care and Evidence-Based Therapy Use

Abstract

Background-The left ventricular ejection fraction (LVEF) has prognostic and therapeutic utility after acute myocardial infarction (AMI). Although LVEF assessment is a key performance measure among AMI patients, contemporary rates of in-hospital assessment and its association with therapy use have not been well characterized. Methods and Results-We examined rates of in-hospital LVEF assessment among 77 982 non-ST-elevation myocardial infarction patients and 50 863 ST-elevation myocardial infarction patients in Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines between January 2007 and September 2009, after excluding patients who died in-hospital or who were transferred to another acute care facility, discharged to end-of-life care, or had missing LVEF assessment status. LVEF assessment increased significantly over time, with higher rates among STelevation myocardial infarction than non-ST-elevation myocardial infarction patients (95.1% versus 91.6%; P<0.001).Excluding patients with prior heart failure did not alter these observations. Significant interhospital variability in LVEF assessment rates was observed. Compared with patients with in-hospital LVEF assessment, patients who did not have LVEF assessed were older and more likely to have clinical comorbidities. In multivariable modeling, lower overall hospital quality of AMI care was also associated with lower likelihood of LVEF assessment (odds ratio for failure to assess LVEF, 1.09; 95% confidence interval, 1.05-1.13 per 10% decrease in defect-free care). Patients with in-hospital LVEF assessment were more likely to be discharged on evidence-based secondary prevention medication therapies compared with patients without LVEF assessment. Conclusions-The assessment of LVEF among patients with AMI has improved significantly over time, yet significant interhospital variability exists. Patients who did not have in-hospital LVEF assessment were less likely to receive evidence-based medications at discharge. These patients represent targets for future quality improvement efforts. (Circ Cardiovasc Qual Outcomes. 2012;5:662-671.)

Temporal Trends in Heart Failure Incidence Among Medicare Beneficiaries Across Risk Factor Strata, 2011 to 2016

“… 39 Furthermore, the use of diagnostic tests, such as echocardiograms, has increased among these patients. 40 , 41 Consistent with our observations, previous studies 42 , 43 have also demonstrated an increase in post-MI incidence of HF, with a concurrent decline in mortality after MI. Similarly, among patients with AF, improvement in life expectancy over time 44 , 45 and the substantial overlap in symptom burden and pathophysiology between AF and HF 46 , 47 may have contributed to the observed temporal increase in the incidence of HF among those with prevalent AF.…”

Quality Control and Reproducibility in M‐Mode, Two‐Dimensional, and Speckle Tracking Echocardiography Acquisition and Analysis: The CARDIA Study, Year 25 Examination Experience

“…[18, 19] For the 2-dimensional echocardiography parameters, the coefficient of variation for LVEDV was higher in our study compared to LVEF. These results are similar to the literature.…”

Disparities of demographics, clinical characteristics, and hospital outcomes of AMI pilgrims vs non-pilgrims—tertiary center experience

“…All demographic data (age, gender, nationality, BMI, and status (residence/hajj)), risk factors (DM [6], HTN [6], smoking, dyslipidemia [6], presence of chronic kidney disease, old cerebrovascular accidents (CVA) ischemic heart disease (IHD), and previous PCI/CABG), clinical presentation (location of AMI), laboratory results (hemoglobin (HB), BUN, creatinine, HB A1c, and troponin (1st and peak quantitative values)), coronary angiography findings (access site (femoral/radial), LM (left main) disease, 3 vessel CAD (coronary artery disease), PCI artery, thrombus aspiration and tirofiban/Aggrastat use), outcomes (in hospital death, length of stay (LOS), LVEF [7] (left ventricular ejection fraction), pulmonary edema, cardiac arrest, cardiogenic shock, history of mechanical ventilation (MV), and history of LVT (left ventricular thrombus)) for each patient were recorded. Data were collected from cath lab records and their case notes including electronic records, echocardiographic, and coronary angiographic reports.…”