Ontological fallacy in heart failure

doi:10.1136/bmj.b1304

Published 31 March 2009, doi:10.1136/bmj.b1304
Cite this as: BMJ 2009;338:b1304

Letters

Heart failure in need of a diagnosis

Ontological fallacy in heart failure

The first 150 words of the full text of this article appear below.

Echocardiography¹ has resulted in the belief that heart failureand reduced ejection fraction are synonymous. Recently, however,the utility of ejection fraction in diagnosis has been underminedby epidemiological studies, which have shown that ejection fractionis continuously distributed in populations with heart failure,²and that survival is the same irrespective of whether thereis heart failure with normal ejection fraction (HFNEF) or withreduced ejection fraction (HFREF).³ ⁴ In effect it is the clinicallabel of heart failure that drives prognosis, not the ejectionfraction. The adoption of a dichotomous value (the divisionof cardiac function into normal and reduced ejection fraction)to describe a continuous variable is now outmoded and unhelpful.

The relative lack of benefit in studies in HFNEF may be a failureof the therapeutic modes of action of the drugs studied, sincethere is no physiological reason why afterload reduction innon-dilated hearts will produce prognostic . . . [Full text of this article]

Hugh F McIntyre, consultant physician

¹ East Sussex NHS Trust, Conquest Hospital, Hastings TN37 7RD

Hugh.mcintyre@esht.nhs.uk