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https://hdl.handle.net/2440/130690
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Type: | Journal article |
Title: | Ejection fraction and mortality: a nationwide register-based cohort study of 499 153 women and men |
Author: | Stewart, S. Playford, D. Scalia, G.M. Currie, P. Celermajer, D.S. Prior, D. Codde, J. Strange, G. |
Citation: | European Journal of Heart Failure, 2021; 23(3):406-416 |
Publisher: | Wiley |
Issue Date: | 2021 |
ISSN: | 1388-9842 1879-0844 |
Statement of Responsibility: | Simon Stewart, David Playford, Gregory M. Scalia, Philip Currie, David S Celermajer, David Prior, Jim Codde, and Geoff Strange, on behalf of the NEDA Investigators |
Abstract: | Aims: We investigated the sex-based risk of mortality across the spectrum of left ventricular ejection fraction (LVEF) in a large cohort of patients in Australia. Methods and results: Quantified levels of LVEF from 237 046 women (48.1%) and 256 109 men undergoing first-time, routine echocardiography (2000–2019) were linked to 119 232 deaths (median 5.6 years of follow-up). Overall, 17.6% of men vs. 8.3% of women had an LVEF <50%. An LVEF <40% was associated with the highest crude cardiovascular-related and all-cause mortality at 5 years (∼20–30% and ∼ 40–50%, respectively). Thereafter, actual cardiovascular-related and all-cause mortality at 5 years in both sexes steeply improved to a nadir LVEF of 65.0–69.9% (reference group). Below this LVEF level, the adjusted hazard ratio (HR) for cardiovascular-related mortality for a LVEF of 55.0–59.9% was 1.36 [95% confidence interval (CI) 1.16–1.59; P < 0.001] in women and 1.21 (95% CI 1.05–1.39; P = 0.008) in men. In women, an LVEF of 60.0–64.9% was also associated with a HR 1.33 (95% CI 1.16–1.52; P < 0.001) for cardiovascular-related mortality. These associations were most striking in women and men aged <65 years and were replicated in those with suspected heart failure (32 403 cases aged 65.2 ± 16.1 years, 57.0% women). For pre-existing heart failure (33 738 cases aged 67.6 ± 16.9 years, 46.5% women), the specific threshold of increased mortality was at and below 50.0–54.9%. Conclusions: Among patients investigated for suspected or established cardiovascular disease, we found clinically relevant sex-based differences in the distribution and mortality associated with an LVEF <65.0–69.9%. Specifically, they suggest a greater risk of mortality at higher LVEF levels among women. |
Keywords: | Left ventricular ejection fraction; mortality; cardiac function; sex-specific; outcomes |
Rights: | © 2020 European Society of Cardiology |
DOI: | 10.1002/ejhf.2047 |
Grant ID: | http://purl.org/au-research/grants/nhmrc/GNT1135894 |
Published version: | http://dx.doi.org/10.1002/ejhf.2047 |
Appears in Collections: | Aurora harvest 4 Medicine publications |
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