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 the index MI had an increased mortality during follow-up (relative risk of death if EF not measured, 1.69; 95% CI, 1.36 to 2.10).
The results presented herein indicate that measurement of LVEF after MI increased over time but was not measured in approximately 20% of the patients with MI within the last decade of the study period. The involvement of a cardiologist in the care of the patient was a strong independent predictor of LVEF measurement, which was also more likely to occur in the case of larger infarctions as reflected by higher peak CK values and when the hospital stay was prolonged.
Thus, within the last decade of the study period, testing for LVEF was not used uniformly in acute MI, a practice that may impact risk stratification and utilization of evidence-based medications after MI. Additionally, as testing for LVEF differs according to patient characteristics, reliance on clinical assessment of EF will result in biased estimates of the prevalence of left ventricular (LV) systolic dysfunction after MI and of outcomes.