title: Natural history of left ventricular ejection fraction in patients with heart failure.
abstract: BACKGROUND
  Patients with heart failure (HF) are typically designated as having reduced or preserved ejection fraction (HFREF, HFPEF) because of the importance of left ventricular ejection fraction (LVEF) on therapeutic decisions and prognosis. Such designations are not necessarily static, yet few data exist to describe the natural history of LVEF over time.
  
  
  RESULTS
  We identified 2413 patients from Kaiser Permanente Colorado with a primary discharge diagnosis of HF between January 1, 2001, and December 31, 2008, who had ≥2 LVEF measurements separated by ≥30 days. We used multi-state Markov modeling to examine transitions among HFREF, HFPEF, and death. We observed a total of 8183 transitions. Women were more likely than men to transition from HFREF to HFPEF (hazard ratio, 1.85; 95% confidence interval, 1.38-2.47). Patients who were adherent to β-blockers were more likely to transition from HFREF to HFPEF (hazard ratio, 1.53; 95% confidence interval, 1.10-2.13) compared with patients who were nonadherent to β-blockers, whereas angiotensin-converting enzyme or angiotensin II receptor blocker adherence was not associated with LVEF transitions. Patients who had a previous myocardial infarction were more likely to transition from HFPEF to HFREF (hazard ratio, 1.75; 95% confidence interval, 1.26-2.42).
  
  
  CONCLUSIONS
  In this cohort of patients with HF, LVEF is a dynamic factor related to sex, coexisting conditions, and drug therapy. These findings have implications for left ventricular systolic function ascertainment in patients with HF and support evidence-based therapy use, especially β-blockers.
authors.affiliation: Kaiser Permanente Colorado Institute for Health Research, Denver.
authors.forename: Christina L
authors.initials: CL
authors.lastname: Clarke
authors.forename: Gary K
authors.initials: GK
authors.lastname: Grunwald
authors.forename: Larry A
authors.initials: LA
authors.lastname: Allen
authors.forename: Anna E
authors.initials: AE
authors.lastname: Barón
authors.forename: Pamela N
authors.initials: PN
authors.lastname: Peterson
authors.forename: David W
authors.initials: DW
authors.lastname: Brand
authors.forename: David J
authors.initials: DJ
authors.lastname: Magid
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Masoudi
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D003120:Colorado; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D012737:Sex Factors; D013318:Stroke Volume / Q000187:drug effects; D016019:Survival Analysis; D016277:Ventricular Function, Left / Q000187:drug effects; D016903:Drug Monitoring
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors
keywords: heart failure; outcomes assessment; prognosis; ventricular ejection fraction