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 care provider during the index hospitalization, and length of hospital stay > 10 days. Characteristics associated with lesser likelihood of EF measurement included older age, greater comorbidity, measurement of EF within 1 year prior to the MI, and history of heart failure. There was no difference between the two groups with regards to prior history of diabetes, hypertension, or reperfusion therapy.
When characteristics univariately associated with EF measurement were entered in a multivariable model, EF measurement prior to index MI was independently associated with lesser use of tests to measure LVEF after the index MI (Table 2). Involvement of a cardiologist as a care provider during the index hospitalization and higher peak CK were independently associated with greater use of tests to measure LVEF. With regards to age, use of tests to measure LVEF was the greatest among persons in the age group of 60 to 74 years and less frequent above the age of 75 years. There was no independent association between male sex, history of heart failure and comorbidity, and LVEF measurement. These associations did not change after adding reperfusion therapy in the models, and there was no interaction between year and age and year and sex.
Table 1—Baseline Characteristics by LVEF Assessment Within 30 Days of Incident MI Occurring Between 1988 and 1998
| Characteristics | LVEF Not Measured
(n = 238) |
LVEF Measured (n = 1,124) | Odds Ratio
(95% CI) |
p Value |
| Years | 0.059 | |||
| 1988-1991 | 26 | 34 | 1 | |
| 1992-1995 | 45 | 39 | 0.67 (0.48-0.94) | |
| 1996-1998 | 29 | 27 | 0.73 (0.50-1.06) | |
| Age, yr | < 0.001 | |||
| <60 | 30 | 30 | 0.67 (0.45-0.97) | |
| 60-74 | 23 | 35 | 1 | |
| At least 75 | 47 | 36 | 0.51 (0.36-0.73) | |
| Male gender | 48 | 56 | 1.39(1.05-1.84) | 0.021 |
| CK | 0.048 | |||
| First tertile | 45 | 37 | 1 | |
| Second tertile | 32 | 31 | 1.18(0.84-1.64) | |
| Third tertile | 20 | 28 | 1.70(1.17-2.49) | |
| Trauma | 3 | 4 | 1.43 (0.62-3.29) | |
| LVEF measured within 1 yr | 26 | 12 | 0.40 (0.29-0.56) | < 0.001 |
| prior to index MI | ||||
| Comorbidity | 0.021 | |||
| None | 33 | 42 | 1 | |
| 1 -2 | 40 | 37 | 0.74 (0.53-1.02) | |
| > 3 | 28 | 21 | 0.61 (0.42-0.87) | |
| Diabetes mellitus | 22 | 21 | 0.93 (0.66-1.31) | 0.68 |
| Hypertension | 60 | 58 | 0.91 (0.69-1.22) | 0.54 |
| Heart failure | 20 | 11 | 0.49 (0.34-0.71) | < 0.001 |
| Cardiologist involved in care | 86 | 93 | 2.12 (1.38-3.25) | < 0.001 |
| Use of reperfusion therapy | 36 | 37 | 1.07 (0.80-1.44) | 0.63 |
| Length of stay > 10 d | 7 | 24 | 4.1 (2.5-6.8) | < 0.001 |
Table 2—Independent Predictors of LVEF Assessment Within 30 Days of Incident MI Occurring Between 1988 and 1998
| Characteristics | Odds Ratio (95% CI) | p Value |
| Years | 0.18 | |
| 1988-1991 | 1 | |
| 1992-1995 | 0.71 (0.49-1.03) | |
| 1996-1998 | 0.78 (0.52-1.18) | |
| Age, yr | 0.003 | |
| <60 | 0.54 (0.35-0.82) | |
| 60-74 | 1 | |
| At least 75 | 0.56 (0.38-0.84) | |
| Male gender | 1.33 (0.96-1.84) | 0.087 |
| CK | < 0.001 | |
| First tertile | 1 | |
| Second tertile | 1.05 (0.73-1.50) | |
| Third tertile | 1.51 (1.00-2.26) | |
| Trauma | 1.00 (0.42-2.39) | |
| Comorbidity | 0.62 | |
| None | 1 | |
| 1 -2 | 0.88 (0.59-1.29) | |
| >3 | 0.79 (0.50-1.27) | |
| History of heart failure | 0.71 (0.45-1.13) | 0.15 |
| EF within 1 yr prior to MI | 0.40 (0.27-0.58) | < 0.001 |
| Cardiologist involved in care | 3.06(1.81-5.16) | < 0.001 |
| Length of stay >10 d | 4.9 (2.9-8.5) | < 0.001 |
Category: Infarction
Tags: ejection fraction, left ventricular function, myocardial infarction
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