Contrary to popular practice, a measure of the heart's pumping function known as “left ventricular ejection fraction” is not associated with the long-term outcomes of hospitalized patients with heart failure, a UCLA-led study of Medicare patients has found. Hospitalized heart-failure patients in all age groups within the study and with all levels of ejection fraction had significantly lower rates of survival after five years and a higher risk of re-hospitalization than people in the United States without heart failure.
The study is the first to use national data to specifically categorize heart failure by three distinct ejection fraction subgroups. Gregg Fonarow, MD '87 (RES '90, FEL '93), Eliot Corday Professor of Cardiovascular Medicine and Science, co-chief of cardiology and director of the Ahmanson-UCLA Cardiomyopathy Center, and Kevin Shah, MD, cardiovascular clinical fellow, led the research at UCLA. The study concluded that better treatments for heart failure and new ways of predicting patient outcomes are needed.
Heart failure occurs when heart muscle is weakened and cannot pump enough blood to meet the body's needs. Ejection fraction is measured by ultrasound and shows how well the heart is pumping. Doctors use ejection fraction to guide treatment of patients with heart failure and estimate their likelihood of re-hospitalization and survival.
Researchers used national data from the American Heart Association's Get With The Guidelines–Heart Failure program and the U.S. Centers for Medicare and Medicaid Services and included 39,982 patients from 254 hospitals admitted for heart failure from 2005 to 2009. The study categorized the patients by three distinct ejection-fraction subgroups: preserved, borderline and reduced.
The findings underscore the serious nature of a diagnosis of heart failure and the long-term risk associated with it, regardless of the heart's estimated pump function. The study suggests cardiologists need to find new strategies to better treat patients with heart failure and to prevent patients from developing heart failure in the first place. The next stage of research will look at the specific causes of death for the different subgroups and determine potential treatment strategies to improve their outcomes.
“Heart Failure with Preserved, Borderline, and Reduced Ejection Fraction: 5-year Outcomes,” Journal of the American College of Cardiology, November 14, 2017
