Abstract Body: Introduction: Left ventricular ejection fraction (LVEF) changes dynamically in patients with heart failure (HF), but data in racially and geographically diverse community-based cohorts is limited. We leveraged The Reasons for Geographic and Racial Differences in Stroke Study (REGARDS) adjudicated HF hospitalization data to assess the prognostic implications of transitions in LVEF.
Hypothesis: Improvement in LVEF among persons with HF is associated with lower risk of mortality.
Methods: REGARDS participants recruited from the 48 contiguous United States who experienced two or more adjudicated HF hospitalizations with available chart abstracted LVEF data were included. Baseline LVEF was categorized as preserved (> 50%) or reduced (<50%). Changes in quantitative LVEF between first and second HF hospitalizations were calculated continuously. Multivariate Cox proportional hazard regression was used to assess the association between longitudinal changes in LVEF and mortality following the second hospitalization, adjusting for demographics, baseline LVEF category, and time between the first and second hospitalization (<1, 1-5, or >5 years).
Results: Among 611 participants with >2 HF hospitalizations, the 196 participants with complete LVEF data in from >2 hospitalizations had a mean age of 73+10 years, 48% were women, and 55% self-reported Black race. LVEF at first hospitalization was 43+16%. The median [25^th-75^th percentile range] time between first and second hospitalizations was 343 [69, 1,129] days, and the mean change in LVEF was -2%+13%. Reduced baseline LVEF category was seen in 54% of participants. Demographics, comorbidities, and medication use were similar among those with stable (absolute LVEF change <5%), increasing, or decreasing LVEF. During follow-up after the second hospitalization, 183 participants died. In models adjusted for the baseline LVEF, a 5% percent increase in LVEF between hospitalizations was associated with 7% lower rate of mortality following the second hospitalization (HR: 0.93, 95% CI: [0.87, 0.99]; p = 0.038).
Conclusion: Among participants in a national, diverse, community-based cohort with HF, increases in LVEF over serial hospitalizations associated with greater time to mortality.