Heart failure: a poor or worsening ejection fraction helped predict mortality

Clinical bottom line (level 2b)

  1. 15% of patients with congestive heart failure were dead within 12 months.
  2. Patients were at increased risk of dying if they had
    • a poor left ventricular ejection fraction
    • a worsening left ventricular ejection fraction
Cintron et al: Circulation 1993; 87: 17-23
Expires October 2003

The study

Retrospective cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: acute hospitals, USA

1446 patients (aged mean 59, ?% male) with congestive heart failure
Patients had echocardiography every 4-12 months during the studies.

Cox proportional regression analysis performed on prognostic factors.

?100% followed for 12 months
Outcomes studied:
  • death

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)    		 NNF
    (95% CI)
    death 12 months 218/1446 15%
    (13% to 17%)    		 7
    (6 to 8)

    • Mortality was independently predicted by
      • baseline left ventricular ejection fraction (LVEF)
      • decrease in LVEF by more than 5%

    Comments

    1. Data taken from two randomised controlled trials on vasodilators in heart failure (V-HeFT I and II).

    Citation

    1. Cintron G, Johnson G, Francis G, et al: prognostic significance of serial changes in left ventricular ejection fraction in patients with congestive heart failure (Suppl VI). Circulation 1993; 87: 17-23
    Contributor: Chris Ball and Clare Wotton, October 1999
    Reviewer:

    Clinical Question.
    Patient heart failure
    Intervention or Exposure prognostic factors
    Outcome death