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% by 1986 (p value for trend < 0.0001) and stabilized thereafter. The distribution of use of individual tests (Fig 1) indicates that the use of radionuclide angiography peaked at 44% in 1985 and declined sharply thereafter. Use of contrast left ventriculography increased from 10% in 1979 to 58% in 1988 and declined somewhat in the more recent years. Use of transthoracic echocardiography for measurement of LVEF increased from 14% in 1979 to 65% in 1986 and stabilized thereafter.
Between 1979 and 1987, 49% of the total number of patients with MI underwent testing to measure LVEF within the first 10 days after MI, with 52% prior to hospital dismissal. Between 1988 and 1998, 81% of the total number of patients with MI underwent testing to measure LVEF within the first 10 days after MI, with 81% prior to hospital dismissal. In 90% of the cases, a cardiologist was either the primary caregiver (83%) or served as a consulting physician (7%). Thus, only a small component of the cohort was not evaluated by a cardiologist (10%). As the utilization of tests to measure LVEF stabilized in the last decade, the rest of the analysis focused on the period 1988 to 1998 to determine the contemporary determinants of LVEF measurements.
Figure 1. Time trends in the assessment of LVEF within 30 days of incident MI, 1979 to 1998. pts = patients.