Abstract 12495: Body Mass Index and In-Hospital Mortality in Acute Heart Failure Patients
Objectives: Observational data suggest that there is a potentially protective effect of increased body mass index (BMI) in chronic heart failure (HF) with reduced left ventricular ejection fraction (LVEF), which has been termed the obesity paradox or reverse epidemiology. However, little is known about the impact of BMI on clinical outcome in patients hospitalized with acute HF (AHF). The present analysis was conducted to explore the relationship of BMI with in-hospital mortality in AHF patients.
Methods: ALARM-HF is a retrospective observational survey of hospitalized patients for AHF in 9 countries (6 European, Turkey, Mexico and Australia). The trial was conducted as a retrospective in-hospital chart audit survey and the diagnosis and classification of AHF were based on the ESC guidelines. The present secondary analysis of the survey assesses differences in clinical phenotype and in-hospital outcomes in 3924 AHF patients categorized by BMI in three groups: A< 24.9 kg/m2, B 25-29.9 kg/m2 (overweight) and C ≥ 30 kg/m2 (obese).
Results: Most patients (65,5 %) had a BMI > 25 kg/m2 (37,8% overweight and 27,7 % obese). There was no difference in baseline LVEF between groups. Patients with higher BMI were between 56-70 years of age, more likely to have higher BP (A 128±39 vs B 135±38 vs C 138±40, p<0.005) and worse NYHA class on admission, and presented more frequently with non-compliance as precipitating factor of AHF. Patients with BMI < 24,9 kg/m2 as well as obese patients had the greatest rate for all-cause in-hospital mortality whereas overweight patients had the lowest rate of adverse outcome (A 9,9% vs B 7.6% vs C 9.8%, p = 0.049).
Conclusion: Overweight and obesity are common in AHF patients and are accompanied by certain differences in clinical characteristics. In patients with AHF, there is a U-shaped relationship, with the worse in-hospital mortality in the lowest and highest BMI categories. There is a need for prospective studies to elucidate the mechanisms for this relationship.
- © 2012 by American Heart Association, Inc.