Department of Medicine, Stanford University School of Medicine, CA (R.L.T., F.H., P.A.H.).
Veterans Affairs Palo Alto Health Care System, Stanford, CA (R.L.T., P.A.H.).
Circ Heart Fail. 2020 Sep;13(9):e006743. doi: 10.1161/CIRCHEARTFAILURE.119.006743. Epub 2020 Sep 1.
The left ventricular ejection fraction (LVEF) guides treatment of heart failure, yet this data has not been systematically collected in large data sets. We sought to characterize the epidemiology of incident heart failure using the initial LVEF.
We identified 219 537 patients in the Veterans Affairs system between 2011 and 2017 who had an LVEF documented within 365 days before and 30 days after the heart failure diagnosis date. LVEF was obtained from natural language processing from imaging and provider notes. In multivariate analysis, we assessed characteristics associated with having an initial LVEF <40%.
Most patients were male and White; a plurality were within the 60 to 69 year age decile. A majority of patients had ischemic heart disease and a high burden of co-morbidities. Over time, presentation with an LVEF <40% became slightly less common, with a nadir in 2015. Presentation with an initial LVEF <40% was more common in younger patients, men, Black and Hispanic patients, an inpatient presentation, lower systolic blood pressure, lower pulse pressure, and higher heart rate. Ischemic heart disease, alcohol use disorder, peripheral arterial disease, and ventricular arrhythmias were associated with an initial LVEF <40%, while most other comorbid conditions (eg, atrial fibrillation, chronic obstructive pulmonary disease, malignancy) were more strongly associated with an initial LVEF >50%.
For patients with heart failure, particularly at the extremes of age, an initial preserved LVEF is common. In addition to clinical characteristics, certain races (Black and Hispanic) were more likely to present with a reduced LVEF. Further studies are needed to determine if racial differences are due to patient or health systems issues such as access to care.
左心室射血分数（LVEF）指导心力衰竭的治疗，但这些数据尚未在大型数据集中系统地收集。我们试图使用初始 LVEF 来描述心力衰竭的发病情况。
我们在退伍军人事务系统中确定了 219537 名患者，这些患者在心力衰竭诊断日期前 365 天内和后 30 天内有记录的 LVEF。LVEF 通过自然语言处理从影像和提供者的记录中获得。在多变量分析中，我们评估了与初始 LVEF<40%相关的特征。
大多数患者为男性和白人；多数为 60 至 69 岁年龄段。大多数患者有缺血性心脏病和多种合并症。随着时间的推移，初始 LVEF<40%的表现变得略不常见，在 2015 年达到最低点。在年轻患者、男性、黑人和西班牙裔患者、住院患者、较低的收缩压、较低的脉压和较高的心率中，初始 LVEF<40%的表现更为常见。缺血性心脏病、酒精使用障碍、外周动脉疾病和室性心律失常与初始 LVEF<40%相关，而大多数其他合并症（如心房颤动、慢性阻塞性肺疾病、恶性肿瘤）与初始 LVEF>50%更相关。
对于心力衰竭患者，特别是年龄较大的患者，初始保留的 LVEF 很常见。除了临床特征外，某些种族（黑人和西班牙裔）更有可能出现 LVEF 降低。需要进一步的研究来确定种族差异是否是由于患者或医疗系统问题，如获得医疗保健的机会。
