To evaluate left ventricular ejection fraction (LVEF) trajectories after an index transthoracic echocardiogram and their association with patient characteristics and guideline-directed medical therapy (GDMT) use in patients with heart failure with reduced ejection fraction (HFrEF), highlighting the clinical significance of these trajectories.
Key Findings:
340,305 individuals with first documented HFrEF; median age 68 years, 45% women. Total number of patients for mortality rates included.
60.4% had follow-up with a cardiologist or primary care physician; 33.8% underwent repeat echocardiogram.
Among those reassessed, 29.2% had persistent HFrEF, 8.1% transitioned to HFimpEF, and 62.7% to HFrEFrem.
12-month mortality rates were 21.3% for persistent HFrEF, 14.0% for HFimpEF, and 11.3% for HFrEFrem, with total patients noted.
GDMT use was modest: 45.2% on ACE inhibitors/ARBs, 55.1% on β-blockers, 14.3% on mineralocorticoid receptor antagonists.
Interpretation:
There is a significant gap between evidence-based guidelines and clinical practice, with many patients not receiving timely LVEF reassessment or adequate GDMT, despite improvements in LVEF, emphasizing the need for change in clinical practice.
Limitations:
Inability to capture contraindications or adverse effects from GDMT.
Potential bias from misclassification and incomplete mortality capture.
Exclusion of nonechocardiogram LVEF assessments and unmeasured differences among patients without follow-up imaging.
Generalizability of findings may be limited due to the specific cohort studied.
Conclusion:
Timely LVEF reassessment and sustained GDMT are essential to improve outcomes in patients with newly identified HFrEF, addressing the identified gaps in practice.
