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Left ventricular ejection fraction digit bias and reclassification of heart failure with mildly reduced vs reduced ejection fraction based on the 2021 definition and classification of heart failure

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http://hdl.handle.net/2183/37198
Creative Commons Attribution 4.0 International License (CC-BY 4.0)
A non ser que se indique outra cousa, a licenza do ítem descríbese como Creative Commons Attribution 4.0 International License (CC-BY 4.0)
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  • Investigación (FCS) [1295]
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Título
Left ventricular ejection fraction digit bias and reclassification of heart failure with mildly reduced vs reduced ejection fraction based on the 2021 definition and classification of heart failure
Autor(es)
Savarese, Gianluigi
Gatti, Paolo
Benson, Lina
Adamo, Marianna
Chioncel, Ovidiu
Crespo-Leiro, María Generosa
Anker, Stefan
Coats, Andrew J.S.
Filippatos, Gerasimos
Lainscak, Mitja
McDonagh, Theresa
Mebazaa, Alexandre
Metra, Marco
Piepoli, Massimo
Rosano, Giuseppe
Ruschitzka, Frank
Seferovic, Petar M.
Volterrani, Maurizio
Maggioni, Aldo P.
Lund, Lars H.
Data
2023-11-15
Cita bibliográfica
Savarese G, Gatti P, Benson L, Adamo M, Chioncel O, Crespo-Leiro MG, Anker SD, Coats AJS, Filippatos G, Lainscak M, McDonagh T, Mebazaa A, Metra M, Piepoli MF, Rosano GMC, Ruschitzka F, Seferovic P, Volterrani M, Maggioni AP, Lund LH. Left ventricular ejection fraction digit bias and reclassification of heart failure with mildly reduced vs reduced ejection fraction based on the 2021 definition and classification of heart failure. Am Heart J. 2024 Jan;267:52-61.
Resumo
[Abstract] Aims: Aims were to evaluate (1) reclassification of patients from heart failure with mildly reduced (HFmrEF) to reduced (HFrEF) ejection fraction when an EF = 40% was considered as HFrEF, (2) role of EF digit bias, ie, EF reporting favouring 5% increments; (3) outcomes in relation to missing and biased EF reports, in a large multinational HF registry. Methods and results: Of 25,154 patients in the European Society of Cardiology (ESC) HF Long-Term registry, 17% had missing EF and of those with available EF, 24% had HFpEF (EF≥50%), 21% HFmrEF (40%-49%) and 55% HFrEF (<40%) according to the 2016 ESC guidelines´ classification. EF was "exactly" 40% in 7%, leading to reclassifying 34% of the HFmrEF population defined as EF = 40% to 49% to HFrEF when applying the 2021 ESC Guidelines classification (14% had HFmrEF as EF = 41% to 49% and 62% had HFrEF as EF≤40%). EF was reported as a value ending with 0 or 5 in ∼37% of the population. Such potential digit bias was associated with more missing values for other characteristics and higher risk of all-cause death and HF hospitalization. Patients with missing EF had higher risk of all-cause and CV mortality, and HF hospitalization compared to those with recorded EF. Conclusions: Many patients had reported EF = 40%. This led to substantial reclassification of EF from old HFmrEF (40%-49%) to new HFrEF (≤40%). There was considerable digit bias in EF reporting and missing EF reporting, which appeared to occur not at random and may reflect less rigorous overall care and worse outcomes.
Palabras chave
Heart failure
Ventricular Function, Left
 
Versión do editor
https://doi.org/10.1016/j.ahj.2023.11.008
Dereitos
Creative Commons Attribution 4.0 International License (CC-BY 4.0)
ISSN
0002-8703

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