scholarly journals Weighing in on heart failure: the potential impact of bariatric surgery

2021 ◽  
Author(s):  
Tanuka Datta ◽  
Andrew J. Lee ◽  
Rachel Cain ◽  
Melissa McCarey ◽  
David J. Whellan
Keyword(s):  
Heart Failure ◽  
Bariatric Surgery ◽  
Weight Loss ◽  
Cardiovascular System ◽  
Economic Burden ◽  
Treatment Strategies ◽  
It Impacts ◽  
Potential Impact ◽  
The Individual ◽  
Physiologic System

AbstractObesity is a growing worldwide epidemic with significant economic burden that carries with it impacts on every physiologic system including the cardiovascular system. Specifically, the risk of heart failure has been shown to increase dramatically in obese individuals. The purpose of this review is to provide background on the individual burdens of heart failure and obesity, followed by exploring proposed physiologic mechanisms that interconnect these conditions, and furthermore introduce treatment strategies for weight loss focusing on bariatric surgery. Review of the existing literature on patients with obesity and heart failure who have undergone bariatric surgery is presented, compared, and contrasted.

Abstract 16013: Evidence for Improvement in NYHA Class and Freedom From Hospitalization in Bariatric Surgery Patients With an Established Diagnosis of Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Michael W Foster ◽  
Sara E Badenhausen ◽  
Colleen Tewksbury ◽  
Noel N Williams ◽  
J Eduardo Rame ◽  
...  
Keyword(s):  
Heart Failure ◽  
Bariatric Surgery ◽  
Weight Loss ◽  
Medical Record ◽  
Median Time ◽  
Severe Obesity ◽  
Nyha Class ◽  
High Volume ◽  
Metabolic And Bariatric Surgery

Introduction: Heart failure patients with severe obesity endure significant morbidity and frequent hospitalizations. Bariatric surgery is proven to provide durable weight loss for those with severe obesity, but the clinical impact and safety of these procedures among patients with heart failure has not been well-demonstrated. Methods: We conducted a medical record query of patients who have a previous diagnosis of heart failure (HFpEF and HFrEF) and underwent subsequent Roux-En-Y gastric bypass or laparoscopic sleeve gastrectomy at a high-volume metabolic and bariatric surgery center. We compared clinical, demographic, and echocardiographic data captured just prior to the bariatric procedure to the most recent data available in the medical record for each patient. Results: There were 50 patients (88% had HFpEF) included in this study. Time from HF diagnosis to most recent follow-up ranged from 0.2 to 20.3 years (median 6.7 years) and there was no recorded mortality. The median time from HF diagnosis to surgery was 2.3 years and median time from surgery to recent follow-up was 2.9 years. Post-operative median decrease in BMI was 8.8 kg/m 2 , HF hospitalizations were 0.4 per patient year (PPY) to 0.15 PPY, p=0.008, and median NYHA Class was II pre-op and I post-op, p=0.048). LVEF, LVESD, and LVEDD were not significantly changed post-operatively (Table 1). Conclusion: Weight loss following bariatric surgery for patients with HF led to improvements in NYHA Class, fewer hospitalizations for HF, and was not associated with perioperative mortality. It is reasonable to consider bariatric surgery for this patient population, but further prospective investigation is warranted.

Medical Management of Endocrine Disorders after Bariatric Surgery

2018 ◽  
Author(s):  
Sangeeta Kashyap
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Cell Function ◽  
Pancreatic Beta Cell ◽  
Sglt2 Inhibitor ◽  
Treatment Strategies ◽  
Glucose Absorption ◽  
Hyperinsulinemic Hypoglycemia ◽  
Endocrine Disorders ◽  
High Fiber

Endocrine complications after bariatric surgery include persistent hyperglycemia in patients with type 2 diabetes who experience initial success with weight loss. This complication occurs in those with a prolonged duration of diabetes (> 8 years) and is related to poor residual pancreatic beta-cell function. Often, weight regain is associated with recurrent diabetes, and strategies that target both weight loss and glycemic control are required. New diabetes agents, such as the SGLT2 inhibitor drug class, offer advantages to diabetes treatment after bariatric surgery. On the other end of the glycemic spectrum, hyperinsulinemic hypoglycemia occurs in patients with and without diabetes prior to surgery and often presents with little or no symptoms (i.e., neuroglycopenia). Treatment strategies involve careful monitoring of blood glucose levels and the use of low-glycemic/high-fiber diets as well as drugs that lower glucose absorption and insulin secretion. Glycemic management after bariatric surgery requires close observation.

scholarly journals Surgical obesity treatment and the risk of heart failure

2019 ◽  
Vol 40 (26) ◽  
pp. 2131-2138 ◽  
Author(s):  
Shabbar Jamaly ◽  
Lena Carlsson ◽  
Markku Peltonen ◽  
Peter Jacobson ◽  
Kristjan Karason
Keyword(s):  
Heart Failure ◽  
Bariatric Surgery ◽  
Weight Loss ◽  
Usual Care ◽  
Study Groups ◽  
Hazard Ratio ◽  
Control Group ◽  
Surgery Group ◽  
Increased Risk ◽  
First Time

Abstract Aims Obesity is associated with increased risk for heart failure. We analysed data from the Swedish Obese Subjects (SOS) study, a prospective matched cohort study, to investigate whether bariatric surgery reduces this risk. Methods and results From the total SOS population (n = 4047), we identified 4033 obese individuals with no history of heart failure at baseline, of whom 2003 underwent bariatric surgery (surgery group) and 2030 received usual care (control group). First-time principal diagnoses of heart failure were identified by crosschecking the SOS database with the Swedish National Patient Register and the Swedish Cause of Death Register using diagnosis codes. During a median follow-up of 22 years, first-time heart failure occurred in 188 of the participants treated with surgery and in 266 of those receiving usual care. The risk of developing heart failure was lower in the surgery group than in the control group [sub-hazard ratio 0.65, 95% confidence interval (CI) 0.54–0.79; P < 0.001]. After pooling data from the two study groups, the quartile of subjects with the largest weight loss after 1 year (mean −41 kg) displayed the greatest risk reduction (sub-hazard ratio 0.51, 95% CI 0.30–0.70; P < 0.001). This association remained statistically significant after adjustment for surgical intervention and potential baseline confounders (sub-hazard ratio 0.60, 95% CI 0.36–0.97; P = 0.038). Conclusion Compared with usual care, bariatric surgery was associated with reduced risk of heart failure among persons being treated for obesity. The risk of heart failure appeared to decline in parallel with a greater degree of weight loss. ClinicalTrials.gov Identifier NCT01479452.

scholarly journals Nonsurgical complications after bariatric surgery

2020 ◽  
Vol 79 (OCE2) ◽  
Author(s):  
Caroline Simoens ◽  
Astrid Verbiest ◽  
Wout Van der Borght ◽  
Amber Van den Eynde ◽  
Karen Brenninkmeijer ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Hospital Admission ◽  
Enteral Feeding ◽  
Treatment Strategies ◽  
Failure To Thrive ◽  
Health Concern ◽  
Micronutrient Deficiencies ◽  
University Hospitals ◽  
Complications After Bariatric Surgery

AbstractThe increasing worldwide prevalence of obesity is a major public health concern, which has led to the development of surgical treatment strategies that achieve long-term sustainable weight loss and improvement of comorbidities and quality of life. However, nonsurgical complications can occur which sometimes necessitate hospital readmission depending on the severity. Current literature about hospital admission for nonsurgical complications after bariatric surgery is especially sparse. We performed a 5-year retrospective analysis of patients admitted for nonsurgical complications after bariatric surgery at the Department of Endocrinology, University Hospitals Leuven (Belgium). Patient and readmission characteristics were described by type of first bariatric surgery performed, time after first surgery, amount of bariatric surgeries in total, reason for hospitalization (nutritional, functional, psychological, metabolic and medical), need for parenteral and enteral feeding during hospitalization and duration of hospitalization. In a period of five years, there were 152 hospitalizations of 107 patients (86% females). The majority of patients (53%) underwent Roux-en-Y gastric bypass (RYGB) and had in total 1 (1–2) bariatric procedures. The median BMI before the first bariatric procedure was 40.7 (37.9–46.7) kg/m2. Patients were admitted 7.6 (3.4–13.1) years after surgery at an average age of 49 ± 12 years. Nutritional (66.4%), functional (37.5%) and co-presenting nutritional-functional (25.0%) problems were the most important reasons for hospitalization. In regard to the nutritional complications, the most important reasons for hospital admission were dumping syndrome (19.7%), macro- and micronutrient deficiencies (16.4%), bad compliance to prescribed nutritional guidelines (14.5%), anorexia (11.2%), extensive weight loss (10.5%) and failure to thrive (9.2%). During hospitalization, parenteral and enteral feeding was started in 19.1% and 9.9% of hospitalizations, respectively. The median duration of all hospitalizations was 8 (4–13) days. To conclude, the majority of hospitalized patients underwent RYGB and was female. Most patients were admitted late after surgery and nutritional problems were the most common complication. Nonsurgical complications after bariatric surgery are a clear illustration of the double-edged sword of surgical obesity management. The exact gastrointestinal anatomical and physiological changes provide the intended effect of weight loss, but may also elicit unintended imbalances of excessive losses of nutrients that compromise the outcome. Our findings demonstrate the need for lifelong multidisciplinary follow-up of lifestyle behavior and education on diet both before and after bariatric surgery.

Impact of weight loss on the cardiovascular system after bariatric surgery

2016 ◽  
Vol 62 (5) ◽  
pp. 43
Author(s):  
Bianca Maria Leca ◽  
Ionuț Stanca ◽  
Suzana Florea ◽  
Simona Fica ◽  
Anca Elena Sîrbu
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Left Ventricle ◽  
Cardiovascular System ◽  
Negative Response ◽  
Obese Patients ◽  
Left Ventricle Mass ◽  
Post Surgery ◽  
Number Of Patients

Introduction. Obesity is a chronic disease with a great impact on the cardiovascular system through its association with type II diabetes, hypertension, dyslipidemia, metabolic syndrome (MetS) and also through direct alterations in cardiac performance and morphology. Recent long term studies prove that substantial weight loss obtained via bariatric surgery is capable of improving cardiac risk factors associated with severe obesity, decreasing the mortality rates.Aim: to assess the long-term changes in cardiovascular risk and cardiac structure in obese patients who had lost weight after laparoscopic sleeve gastrectomy (LSG).Methods. Fifty-two severe obese patients (44±9 years, 57.7% women, BMI=45±8 kg/m2) underwent clinical and biochemical examination and Doppler echocardiograms before and 5 years after LSG.Results. Pre-operatively, 78.4% of patients were hypertensive, 46.2% had diabetes, 73.1% MetS and 44.2% presented left ventricle hypertrophy (LVH), reflecting high cardio-metabolic risk. The patients reassessment was made 61.7±10.5 months after LSG, when a decrease in BMI of 21.9±10% was achieved (p<0.001). The prevalence of hypertension (64.7%), diabetes (32.7%) and MetS (28.8%) decreased compared to the pre-operative examination (p=0.019, p<0.001, p=0.036). An increase in left ventricle mass and left ventricle mass index (LVMI) (p<0.001) and in the prevalence of LVH (57.7%-p=0.001) was recorded. Patients were divided into two groups based on the decrease in LVMI (positive response-38.5%) or increase in LVMI post-surgery (negative response-61.5%), compared with pre-operative values. The group of patients with negative response had lost less weight (p=0.006), had a poor glycemic control (p=0.022), and higher systolic (p=0.004) and diastolic (p=0.030) pressure values compared to the first evaluation.Conclusion. The increase of LVMI after LSG indicates that this study should continue, including a larger number of patients. It is important to identify the factors that can predict an inappropriate response to surgery, in order to prevent and treat them.

P3812The economic burden of heart failure in Denmark from 1998 to 2016

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J S Bundgaard ◽  
U M Mogensen ◽  
S Christensen ◽  
U M Ploug ◽  
R Roerth ◽  
...  
Keyword(s):  
Heart Failure ◽  
Health Care ◽  
Health Care Costs ◽  
Economic Burden ◽  
Indirect Costs ◽  
Economic Consequences ◽  
Control Group ◽  
Background Population ◽  
The Individual ◽  
Care Costs

Abstract Background Heart failure (HF) imposes a large burden on the individual as well as society and the aim of this study was to investigate the economic burden attributed to direct and indirect costs of patients with HF before, at, and after time of diagnosis. Methods Using Danish nationwide registries we identified all patients >18 years with a first-time diagnosis of HF from 1998–2016 and matched them 1:1 with a control group from the background population on age, gender, marital status, and educational level. The economic analysis of the total costs after diagnosis was based on direct costs including hospitalization, procedures, medication, and indirect costs including social welfare and lost productivity to estimate the annual cost of HF. Results We included a total of 176,067 HF patients with a median age of 76 years, and 55% were male. Patients with HF incurred an average of €17,039 in sum of total annual direct (€11,926) and indirect (€5,113) health-care costs peaking at year of diagnosis compared to €5,936 in the control group with the majorityattributable to inpatient admissions. The total annual net costs including social transfer after index HF were €11,957 higher in patients with HF compared to controls and the economic consequences increased markedly 2 years prior to the diagnosis of HF (Figure 1). Conclusion Patients with HF impose significantly higher total annual health-care costs compared to a matched control group with findings evident more than 2 years prior to HF diagnosis Acknowledgement/Funding Novartis

scholarly journals Effect of various weight loss interventions on serum NT-proBNP concentration in severe obese subjects without clinical manifest heart failure

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Tim Hollstein ◽  
Kristina Schlicht ◽  
Laura Krause ◽  
Stefanie Hagen ◽  
Nathalie Rohmann ◽  
...  
Keyword(s):  
Heart Failure ◽  
Weight Loss ◽  
Gastric Bypass ◽  
Sleeve Gastrectomy ◽  
Serum Concentration ◽  
Bypass Surgery ◽  
Gastric Bypass Surgery ◽  
Very Low Calorie Diet ◽  
Calorie Diet ◽  
The Individual

AbstractObesity is associated with a “natriuretic handicap” indicated by reduced N-terminal fragment of proBNP (NT-proBNP) concentration. While gastric bypass surgery improves the natriuretic handicap, it is presently unclear if sleeve gastrectomy exhibits similar effects. We examined NT-proBNP serum concentration in n = 72 obese participants without heart failure before and 6 months after sleeve gastrectomy (n = 28), gastric bypass surgery (n = 19), and 3-month 800 kcal/day very-low calorie diet (n = 25). A significant weight loss was observed in all intervention groups. Within 6 months, NT-proBNP concentration tended to increase by a median of 44.3 pg/mL in the sleeve gastrectomy group (p = 0.07), while it remained unchanged in the other groups (all p ≥ 0.50). To gain insights into potential effectors, we additionally analyzed NT-proBNP serum concentration in n = 387 individuals with different metabolic phenotypes. Here, higher NT-proBNP levels were associated with lower nutritional fat and protein but not with carbohydrate intake. Of interest, NT-proBNP serum concentrations were inversely correlated with fasting glucose concentration in euglycemic individuals but not in individuals with prediabetes or type 2 diabetes. In conclusion, sleeve gastrectomy tended to increase NT-proBNP levels in obese individuals and might improve the obesity-associated “natriuretic handicap”. Thereby, nutritional fat and protein intake and the individual glucose homeostasis might be metabolic determinants of NT-proBNP serum concentration.

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