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A propensity-matched study of moderate to severe obesity and mortality in heart failure

Session Poster Session 2

Speaker Pao-Hsien Chu

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure: Lifestyle Modification
  • Session type : Poster Session

Authors : P Chu (Taipei,TW), YY Lu (Tao-Yuan,TW)

Authors:
P Chu1 , YY Lu2 , 1Chang Gung Memorial Hospital Tapei - Taipei - Taiwan, Province of China , 2Linkou Chang Gung Memorial Hospital, Cardiology - Tao-Yuan - Taiwan, Province of China ,

Citation:

Background

Obesity has been shown to be an independent risk factor for cardiovascular morbidity and developing heart failure. However, a plethora of evidence supports "obesity paradox" in heart failure patients. In the Taiwan Society of Cardiology-Heart Failure with Reduced Ejection Fraction (TSOC-HFrEF) registry, an inverse association between body mass index (BMI) levels and all-cause mortality has also been proven in Taiwanese heart failure population. The study divided heart failure patients by BMI into 4 groups, and obesity was defined as BMI=27. We think there may exist controversy that patients with more than moderate obesity (body mass index ==30 kg/m2) may not have the same survival advantage as their counterparts. Therefore, this study aimed to investigate the associations of moderate to severe obesity (defined as BMI=30 kg/m2 in Taiwan) with heart failure patients’ outcome.

Method

Patients who were admitted to our Hospital during Aug 2013 and Dec 2014 with the diagnosis of acute decompensated heart failure were enrolled retrospectively. Patients with BMI=30 were selected as severe obesity group. Control group were selected from the other patients by 1:2 propensity score matching to balance the baseline condition and comorbidity. The primary outcome was the occurrence of all-cause death, and the secondary outcome was the occurrence of cardiac death during 3-year follow-up. All death was considered cardiac unless there was a clear noncardiac cause. We used Kaplan-Meier and Log Rank analyses to compare the all cause mortality and cardiac death between the 2 groups.

Result

984 patients were enrolled in this study. Of these patients, 42 (4.2%) were BMI=30. Only 32 patients passed the propensity matching test and other 64 patients with BMI<30 were selected as control. The mean BMI were 32.37 in the severe obesity group and 24.35 in the control group. Their baseline characteristics are shown in Table 1. There are significant differences in clinical characteristics between 2 groups, with a lower incidence of hypertension and lower level of B-type natriuretic peptide (BNP) in the obesity group. There is no significant difference in other clinical characters. During 1-year follow-up, 3 were lost follow up in the obesity group and 8 in the control group. The incidence of all-cause mortality (10% vs 9%, p=0.678) does not differ significantly between the 2 groups. After 3-year follow-up, another 6 were lost follow up in the obesity group and 5 in the control group. There is still no significant difference of all-cause mortality (26% vs 18%, p=0.118). But the obesity group has more incidence of cardiac death (26% vs 12%, p=0.004).

Conclusion

Heart failure patients with moderate to severe obesity may not share the same survival benefit as mild obesity patients. However, this study result is limited by the small number of populations.

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