Redefining Heart Failure With a Reduced Ejection Fraction

Butler, Javed; Anker, Stefan D.; Packer, Milton

doi:10.1001/jama.2019.15600

Cited by 56 publications

(49 citation statements)

References 10 publications

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“…36 Our approach allowed us to examine the effects of 10% decrements in LVEF, since some investigators have debated the appropriate cutoff values of ejection fraction especially in the context of HF. 37 All echocardiographic sites were tertiary academic hospitals. Rural sites or community-based echocardiographic labs were not represented in this cohort.…”

Section: Discussionmentioning

confidence: 99%

Association of Left Ventricular Ejection Fraction with Mortality and Hospitalizations

Angaran

Dorian

et al. 2020

Journal of the American Society of Echocardiography

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Background: Although echocardiography is widely used to measure left ventricular ejection fraction (LVEF), its prognostic value has not been demonstrated in a broad range of patients including those acutely hospitalized for cardiac or noncardiac causes. We determined whether greater degrees of left ventricular systolic dysfunction were associated with progressively increasing risks of death or cardiovascular hospitalizations among patients in hospital or outpatient settings. Methods: A total of 27,323 patients with LVEF measured and 19,445 matched controls were followed for 223,034 person-years. Outcomes of total mortality, cardiovascular death, cardiovascular hospitalizations, and heart failure hospitalizations were examined using cause-specific hazard competing-risks analysis.

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Section: Discussionmentioning

confidence: 99%

Association of Left Ventricular Ejection Fraction with Mortality and Hospitalizations

Angaran

Dorian

et al. 2020

Journal of the American Society of Echocardiography

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“…Medical records for suspected events were retrieved, and hospitalizations for HF and myocardial infarctions (MI) were confirmed by trained clinicians following published guidelines [13][14][15]. Using hospital records from confirmed HF hospitalizations, the left ventricular ejection fraction (LVEF) was classified as reduced (LVEF < 50% or qualitative report of abnormal LVEF) or preserved (LVEF ≥ 50% or qualitative report of normal LVEF) [16]. Hospitalizations for stroke events were confirmed by a panel of neurologists following the World Health Organization definition [17].…”

Section: Outcomes Identificationmentioning

confidence: 99%

Gout is associated with an increased risk for incident heart failure among older adults: the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort study

et al. 2020

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Background: Gout has been associated with a higher risk for coronary heart disease (CHD) and stroke in some prior studies. Few studies have assessed the association of gout with incident heart failure (HF). Methods: We analyzed data from 5713 black and white men and women ≥ 65.5 years of age in the populationbased REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort study who had Medicare coverage without a history of HF, CHD, or stroke at baseline between 2003 and 2007. Gout was defined by ≥ 1 hospitalization or ≥ 2 outpatient visits with a diagnosis code for gout in Medicare claims prior to each participant's baseline study examination. REGARDS study participants were followed for HF hospitalization, CHD, stroke, and all-cause mortality as separate outcomes through December 31, 2016. Analyses were replicated in a random sample of 839,059 patients ≥

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“…Left ventricular ejection fraction (EF), the portion of blood pumped out by the left ventricle with each contraction, is one of the most important measurements in diagnosing and defining stages of HF. 37 Under the definitions provided by the American Society of Echocardiography and the European Association of Cardiovascular Imaging, 38 EF measurements are classified into 4 categories: normal (EF >51% in men and EF >53% in women), mildly abnormal (EF between 41%–51% in men and 41%–53% in women), moderately abnormal (EF within 30%–40% in men and women), and severely abnormal (EF <30% in men and women). EF severity may be reflected in HF patients’ changing conditions such as shortness of breath and reduced ability for physical activity.…”

Section: Methodsmentioning

confidence: 99%

Using electronic health records for population health sciences: a case study to evaluate the associations between changes in left ventricular ejection fraction and the built environment

et al. 2020

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Objective Electronic health record (EHR) data linked with address-based metrics using geographic information systems (GIS) are emerging data sources in population health studies. This study examined this approach through a case study on the associations between changes in ejection fraction (EF) and the built environment among heart failure (HF) patients. Materials and Methods We identified 1287 HF patients with at least 2 left ventricular EF measurements that are minimally 1 year apart. EHR data were obtained at an academic medical center in New York for patients who visited between 2012 and 2017. Longitudinal clinical information was linked with address-based built environment metrics related to transportation, air quality, land use, and accessibility by GIS. The primary outcome is the increase in the severity of EF categories. Statistical analyses were performed using mixed-effects models, including a subgroup analysis of patients who initially had normal EF measurements. Results Previously reported effects from the built environment among HF patients were identified. Increased daily nitrogen dioxide concentration was associated with the outcome while controlling for known HF risk factors including sex, comorbidities, and medication usage. In the subgroup analysis, the outcome was significantly associated with decreased distance to subway stops and increased distance to parks. Conclusions Population health studies using EHR data may drive efficient hypothesis generation and enable novel information technology-based interventions. The availability of more precise outcome measurements and home locations, and frequent collection of individual-level social determinants of health may further drive the use of EHR data in population health studies.

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Redefining Heart Failure With a Reduced Ejection Fraction

Cited by 56 publications

References 10 publications

Association of Left Ventricular Ejection Fraction with Mortality and Hospitalizations

Association of Left Ventricular Ejection Fraction with Mortality and Hospitalizations

Gout is associated with an increased risk for incident heart failure among older adults: the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort study

Using electronic health records for population health sciences: a case study to evaluate the associations between changes in left ventricular ejection fraction and the built environment

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