Background
- Obesity is a major risk factor for heart failure. However, many studies have shown that obesity is paradoxically associated with better outcomes in those with chronic heart failure (HF). Initially thought to occur only in those with left ventricular systolic dysfunction (LVSD), recent studies such as CHARM and I-PRESERVE have described the same phenomenon in those with HF with preserved ejection fraction (HFpEF). It is also known that minorities have the highest rates of obesity in the United States, yet no major studies have included a large enough sample (>10% minority representation) to study this relationship. Thus we propose to examine the relationship of different weight categories to HF outcomes in patients with LVSD (45%) utilizing a minority cohort.
Methods
- Outcomes (HF admissions & cardiac admissions, non-cardiac admissions, and emergency room visits) were assessed for162 HF patients with documentation of body mass index (BMI) and ejection fraction from the Meharry Heart Failure Registry (a registry composed of 80% African Americans and Hispanics). The cohort was evenly divided by EF into HFpEF versus LVSD. Utilizing the Center for Disease Control definitions, 5 categories for BMI were defined: 40.0. ANOVA was applied to test for possible differences among BMI groups and outcomes.
Results
- There was a trend towards a paradoxical relationship noted between BMI and outcome in males with HFpEF when looking at all-cause readmissions (p<0.0606). This same relationship was noted between BMI and outcome in women with HFpEF when looking at the all-cause emergency room visits (p<0.0677). However, we failed to find a significant difference across BMI categories and outcome for those with LVSD.
Conclusion
- Our study suggests that irrespective of race, there is a paradoxical relationship noted between BMI and outcome for both men and women with HFpEF. However, contrary to current literature, we failed to find the same relationship in minority patients with LVSD. This may be due to the small sample size hence a larger prospective study of this group is warranted.
THE HEART FAILURE RAPID INTERVENTION CLINIC: IS IT POSSIBLE TO DECREASE EMERGENCY ROOM VISITS AND RE-ADMISSIONS THROUGH OUT-PATIENT HEART FAILURE THERAPY?
