Abstract 9181: Does a Low Ejection Fraction Predict Mortality? Insights From the ASCEND-HF Trial
Background: Acute heart failure (AHF) is associated with significant morbidity and mortality. Limited data exist assessing the relationship between left ventricular ejection fraction (EF) and outcomes in patients with AHF.
Methods: We explored the association between EF and 30-day and 180-day mortality in AHF patients enrolled in the Acute Studies of Nesiritide in Decompensated Heart Failure (ASCEND-HF) trial. EF was analyzed as a continuous variable and as 3 categories: 50%(PresEF).
Results: Of the 7007 patients in the trial, EF was available in 5687 (81.2%) patients: 4474 (78.7%) had LowEF, 674 (11.9%) had IntEF, and 539 (9.5%) had PresEF. Compared to LowEF patients, those with IntEF and Pres EF were older, more likely to be female, have atrial arrhythmias, diabetes, and higher systolic blood pressure, and lower heart rate, respiratory rate and BNP. The unadjusted 30-day 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% CI: 0.75-1.24; p = 0.77), and IntEF (0.91, 95% CI 0.66-1.3; p = 0.58) compared to the PresEF group. By contrast, when EF was evaluated as a continuous measure, it exhibited a U-shaped relationship, i.e. the lowest risk of 30-day and 180-day death occurred at an EF of 35%. After matching for age and sex, the mortality risk attributed to EF was attenuated for patients with an EF > 35%, but the mortality risk increased exponentially if the EF was < 35%. (Fig.
Conclusions: Among patients with AHF, 30-day and 180-day mortality is similar for those with IntEF or PresEF but increases exponentially for those with LowEF after accounting for key patient variables. Prior observations of a similar mortality risk for AHF patients with a higher EF need to be reevaluated.
- © 2012 by American Heart Association, Inc.