While routine assessment of LVEF may be challenged in subjects with minimal myocardial damage as determined by novel biomarkers, our findings apply to MIs ascertained using CK/CK-MB only, as troponin was not used in Olmsted County at that time. The racial and ethnic composition of Olmsted County is becoming more diverse, but during the study…
An ancillary survival analysis indicated that patients without LVEF assessment had worse survival. As in any observational study, residual confounding may account for this association. However, this underscores that the use of clinically indicated tests to measure the prevalence of LV dysfunction after MI and/or to ascertain outcomes is confounded by indication and will likely…
Recent data underscored the association between the specialty of the ambulatory physician and the delivery of care among MI survivors. The present study extends these findings by demonstrating a positive association between the involvement of a cardiologist as a care provider and the measurements of LVEF among all consecutive patients from a geographically defined population…
The results presented herein extend previously reported findings by indicating that during the last 20 years, the use of tests to measure LVEF increased dramatically during the first decade characterized by rapid incorporation of new technology in practice. Its use, however, stabilized over the last decade. Thus, the use of testing to measure LVEF did…
While some studies reported that an approximate estimation of LVEF can be performed clinically in 40% of patients after MI, the practical value of such scoring systems is limited. Indeed, stud-ies reported associations between several clinical indicators and abnormal LVEF, but these studies consisted of relatively small case series and the proposed prediction algorithms were…
After adjusting for comorbidities and for other determinants of LVEF testing (including age, sex, year, peak CK, history of heart failure and comorbidity, EF measurement prior to index MI, cardiologist involved as care provider, length of stay > 10 days and reperfusion), patients who did not have an assessment of LVEF within 30 days of…
Characteristics Associated With Testing To Measure LVEF Table 1 compares the characteristics of patients who underwent measurement of LVEF within 30 days after an incident MI between 1988 and 1998 to those who did not. Characteristics associated with greater likelihood of ejection fraction (EF) measurement included male sex, higher peak CK, cardiologist involved as a…
Time Trends of Testing To Measure LVEF After MI Between 1979 and 1998, 2,317 subjects in Olmsted County were hospitalized with an incident MI. The percentage of patients undergoing testing for LVEF within 30 days after MI over time is shown in Figure 1. The use of testing increased from 22% in 1979 to 85%…
The Mantel-Haenszel x2 test for trend was used to analyze the change in the proportion of patients tested for LVEF over time, and the Pearson x2 test was used to compare proportions. Logistic regression was used to examine the independent association between demographic and clinical variables, and testing for LVEF within 30 days after index…
The procedures used to assemble the MI incidence cohort have been reported in detail elsewhere. Briefly, all incident MIs between 1979 and 1998 were ascertained from indexes of medical diagnosis and hospital discharges using standardized epidemiologic criteria, relying on cardiac pain, creatine phos-phokinase enzyme values, and Minnesota coding of the ECG.
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