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Measurement of Ejection Fraction After Myocardial Infarction in the Population: Characteristics Associated

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
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