Left Ventricular Ejection Fraction Assessment in Patients with Congestive Heart Failure
Background: The US Agency for Health Care Policy and Research guidelines state that any patient with suspected heart failure should have ejection fraction assessment performed. This study describes factors associated with left ventricular ejection fraction (LVEF) assessment in patients with congestive heart failure (CHF). Methods: A random sample of 1608 patients aged 65 and older were selected from all fee-for-service Medicare beneficiaries discharged from California hospitals in 1998 with a principal diagnosis of CHF. Patients were excluded if a diagnosis of CHF was not confirmed, if the patient died, was transferred to another acute care facility, left against medical advice, or had a procedure code for dialysis. The outcome measure was LVEF assessment. Results: After exclusions, 1562 patients remained of whom 1000 (64%) had LVEF either assessed during this hospitalization, prior to this hospitalization, or had a documented plan for LVEF evaluation after discharge. In multivariate analysis, controlling for age, gender, race, and past history of CHF, patients who did not have a LVEF assessment were less likely to have been prescribed an angiotensin converting enzyme (ACE) inhibitor (Odds Ratio=0.25, 95% Confidence Interval=0.20-0.31). Patients age 85 years and older were less likely to have LVEF assessed (OR=1.52, 95% CI=1.13-2.05). Conclusion: CHF patients who do not have a LVEF assessment are much less likely to receive an ACE inhibitor. Over one third of CHF patients do not undergo LVEF assessment, contributing to under-prescription of ACE inhibitors in CHF. Efforts to improve quality of care for CHF patients may need to promote LVEF assessment as a first step in CHF management.