Abstract 17066: Influence of Extreme Obesity on Mortality in Systolic Heart Failure
Objectives: Obesity is a major cardiovascular risk factor; however, several studies have shown a mortality improvement in obese patients with established heart failure (HF) whereas others have discredited this “obesity paradox.” Unfortunately, there is little data considering the relationship of BMI and HF beyond patients categorized as overweight or obese or in patients stratified by ejection fraction (EF). We extend these studies to evaluate HF in the setting of extreme obesity (BMI > 40) with regard to EF in a 12,181 patient retrospective study.
Methods: In a retrospective review over 8 years, 12,181 patients receiving nuclear stress tests at a tertiary care center were stratified based on BMI and EF and compared to social security death records to evaluate mortality with respect to obesity in the HF setting.
Results: Within obesity class, patients with systolic HF (EF < 50%) had significantly higher mortality than patients with preserved EF (EF > 50%) (p < 0.05 between all obesity classes). In patients with EF > 50%, normal BMI and underweight patients had significantly higher mortality than any obese patient (p < 0.05); however, there was no difference in mortality between obesity classes (p = ns). For EF < 50%, non-obese groups had higher mortality than obese groups (p < 0.05) and extremely obese patients had the lowest mortality (p < 0.05) (Figure 1).
Conclusion: Among patients that are obese there may exist a mortality benefit to increased BMI in the HF setting. Further, this benefit persists at extreme obesity (BMI > 40) and even improves in patients with systolic HF; however, in patients with preserved EF, extremely obese patients have a similar prognosis as obese and overweight patients. Not only do these results agree with literature supporting the “obesity paradox,” but also the data suggest that the intrinsic qualities of HF in the obesity setting are unique, and increasing levels of obesity confer improved prognosis in systolic HF but not in patients with preserved EF.
- © 2013 by American Heart Association, Inc.