Known and missing left ventricular ejection fraction and survival in patients with heart failure: a MAGGIC meta-analysis report.

Pubmed ID: 23803952

Journal: European journal of heart failure

Publication Date: Nov. 1, 2013

MeSH Terms: Humans, Male, Female, Aged, Aged, 80 and over, Middle Aged, Heart Failure, Multivariate Analysis, Prognosis, Stroke Volume, Echocardiography, Documentation, Outcome and Process Assessment, Health Care

Grants: SCD/01

Authors: Poppe KK, Squire IB, Whalley GA, Køber L, McAlister FA, McMurray JJ, Pocock S, Earle NJ, Berry C, Doughty RN, Berry C, Doughty R, Granger C, Køber L, Massie B, McAlister F, McMurray J, Pocock S, Poppe K, Swedberg K, Somaratne J, Whalley G, Ahmed A, Andersson B, Bayes-Genis A, Cowie M, Cubbon R, Ezekowitz J, Gonzalez-Juanatey J, Gorini M, Gotsman I, Grigorian-Shamagian L, Guazzi M, Kearney M, Komajda M, di Lenarda A, Lenzen M, Lucci D, Macín S, Madsen B, Maggioni A, Martínez-Sellés M, Oliva F, Rich M, Richards M, Senni M, Squire I, Taffet G, Tarantini L, Tribouilloy C, Troughton R, Tsutsui H, Earle N, Gamble GD, Ariti C, Dobson J, Doughty RN, Hall C, Lainchbury J, Hogg K, Norrie J, Stevenson K, Brett M, Pfeffer MA, Granger CB, Held P, McMurray JJ, Michelson EL, Olofsson B, Ostergren J, Yusuf S, Torp-Pedersen C, Lenzen MJ, Scholte Op Reimer WJ, Boersma E, Vantrimpont PJ, Follath F, Cleland J, Zwas D, Planer D, Azaz-Livshits T, Admon D, Lotan C, Keren A, Varela-Roman A, Mazón-Ramos P, Rigeiro-Veloso P, Bandin-Dieguez MA, Gonzalez-Juanatey JR, Myers J, Arena R, McAlister FA, Armstrong PW, Cujec B, Paterson I, Cowie MR, Wood DA, Coats AJ, Thompson SG, Suresh V, Poole-Wilson PA, Sutton GC, Robles JA, Prieto L, Muñoa MD, Frades E, Díaz-Castro O, Almendral J, Faggiano P, Bertoli D, Porcu M, Opasich C, Tavazzi L, Maggioni AP, Kirk V, Bay M, Parner J, Krogsgaard K, Herzog TM, Boesgaard S, Hassager C, Nielsen OW, Aldershvile J, Nielsen H, Kober L, Macín SM, Perna ER, Cimbaro Canella JP, Alvarenga P, Pantich R, Ríos N, Farias EF, Badaracco JR, Madsen BK, Hansen JF, Stokholm KH, Brons J, Husum D, Mortensen LS, Vazquez R, Puig T, Fernandez-Palomeque C, Bardají A, Pascual-Figal D, Ordoñez-Llanos J, Valdes M, Gabarrus A, Pavon R, Pastor L, Gonzalez-Juanatey JR, Almendral J, Fiol M, Nieto V, Macaya C, Cinca J, Bayes de Luna A, Newton JD, Blackledge HM, Squire IB, Wright SP, Whalley GA, Kerzner R, Gage BF, Freedland KE, Rich MW, Huynh BC, Rovner A, Freedland KE, Carney RM, Rich MW, Taffet GE, Teasdale TA, Bleyer AJ, Kutka NJ, Luchi RJ, Rusinaru D, Mahjoub H, Soulière V, Lévy F, Peltier M, Tsuchihashi M, Takeshita A, Maccarthy PA, Kearney MT, Nolan J, Lee AJ, Prescott RJ, Shah AM, Brooksby WP, Fox KA, Varela-Roman A, Gonzalez-Juanatey JR, Basante P, Trillo R, Garcia-Seara J, Martinez-Sande JL, Gude F

Cite As: Poppe KK, Squire IB, Whalley GA, Køber L, McAlister FA, McMurray JJ, Pocock S, Earle NJ, Berry C, Doughty RN, Meta-Analysis Global Group in Chronic Heart Failure. Known and missing left ventricular ejection fraction and survival in patients with heart failure: a MAGGIC meta-analysis report. Eur J Heart Fail 2013 Nov;15(11):1220-7. Epub 2013 Jun 26.

Studies:

Abstract

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.