Heart failure & cardiomyopathies
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
Authors' conclusion
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.
Study context
- Population
- Patients in the European Society of Cardiology (ESC) HF Long-Term registry17% missing EF
- Participants
- 25,154 patients
- Exposure
- 2021 vs 2016 ESC EF classification of HF
- Outcome
- Reclassification from HFmrEF to HFrEF when EF = 40% considered HFrEF
Methodological detailsmultinational, ESC HF Long-Term registry
- Multinational
- ESC HF Long-Term registry
Main finding
As reported in the abstract
- HFpEF (EF≥50%), 2016 classification (of those with EF)
- 24%
- HFmrEF (40%-49%), 2016 classification
- 21%
- HFrEF (<40%), 2016 classification
- 55%
- EF exactly 40%
- 7%
- HFmrEF (40%-49%) reclassified to HFrEF under 2021 classification
- 34%
- HFmrEF (EF 41% to 49%), 2021 classification
- 14%
- HFrEF (EF≤40%), 2021 classification
- 62%
Observational data: associations, not effects.
Further findings
EF digit bias (values ending in 0 or 5)
- EF reported as value ending with 0 or 5
- ∼37%
- Digit bias associated with more missing values for other characteristics and higher risk of all-cause death and HF hospitalization
Outcomes with missing EF
- Missing EF associated with higher risk of all-cause and CV mortality and HF hospitalization vs recorded EF
Original publication
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. Published 15 November 2023. doi:10.
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