Abstract 17846: Weighing The Evidence: Geographic Variation And The Obesity Paradox In Patients With Acute Decompensated Heart Failure In The Ascend-hf Trial
Background: A paradox has been previously described in heart failure (HF) where obese patients have a better prognosis than their less obese counterparts. However, geographic variability in the obesity paradox has not been previously explored.
Methods: ASCEND-HF was a randomized trial evaluating nesiritide in ADHF patients. Patients were classified based on weight and height at study entry as normal weight (BMI <24.9 kg/m2), overweight (BMI 25.0 - 29.9), and obese (BMI ≥30). Logistic regression was used to test the association between BMI and Day 30 mortality, 30 day mortality/all-cause readmission and 30 day mortality/HF readmission.
Results: Among 6943 patients, 34.1% were normal; 30.8% overweight; and 35.1% obese. A higher proportion of patients in Central Europe and North America were obese, whereas patients in Asia_Pacific were more commonly classified as normal BMI (Table 1). Obese patients had lower observed 30-day mortality but higher rehospitalization rates. After adjustment, larger BMI was associated with increased risk of 30-day death/all-cause readmission (Odds Ratio: 1.02 (1.01, 1.03) per 1 kg/m2; p=0.003) but not 30 day mortality (Odds Ratio: 0.99 (0.97, 1.02); p=0.62). After further adjusting for geographic region BMI was no longer significantly associated with worse 30-day death/all-cause readmission (p=0.15), nor 30-day mortality/HF readmission (Odds Ratio: 1.01 (0.99,1.02); p=0.70) and we did not observe differential association of BMI with outcomes by region (interaction p>0.09 for all outcomes.)
Conclusion: Obesity varies significantly across geographic regions with North America having the largest proportion of obese patients. BMI was not significantly associated with day-30 outcomes.
- © 2013 by American Heart Association, Inc.