Abstract P302: Lack of Obesity Paradox in 30 Day and Annual Cumulative Acute Decompensated Heart Failure Readmissions

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Ravinder Valadri ◽  
Namrata Singhania ◽  
Deborah Deborah ◽  
Richard English ◽  
LeYu Naing ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Obesity Paradox ◽  
Normal Weight ◽  
Study Cohort ◽  
Data Sets ◽  
Index Hospitalization ◽  
Unplanned Hospitalizations ◽  
End Stage

Background: Recent study demonstrated paradoxical relationship between body mass Index (BMI) and all cause mortality in patients with acute decompensated heart Failure (ADHF), where higher BMI was associated with decreased mortality. We sought to test whether this relationship exists between BMI and ADHF readmissions Methods: Consecutive patients presented to the emergency department from March 2014 to July 2015 with the diagnosis of ADHF were analyzed in a retrospective cohort study. Cohort was grouped in to prespecified BMI categories; normal weight (BMI <26 Kg/m2 ), Over weight (BMI 25-30 Kg/m2 ) and Obese (BMI >30 Kg/m2 and above). Primary endpoints were incidence of 30 day ADHF readmission and time to first ADHF readmission from the index hospitalization. Patients with end stage COPD on home O2, cirrhosis and end stage renal failure on dialysis were excluded. Unplanned hospitalizations due to other cause than ADHF were excluded. ADHF hospitalizations were adjudicated by an independent blinded clinician Results: Cohort (N=188) consisted 51(27.1%) normal weight, 61 (32.4%) over weight and 76 (40.4%) obese patients. Females were 63% (N=119), patients with heart failure with preserved ejection fraction were 47% (N=90), Obese [BMI 31(28-38) Kg/m2; Median (IQR)] patients were younger (median age; 77 years vs 83 years; P=0.002), whereas other covariates were similar between groups. In median follow up of 1.2 years, total 30 day ADHF readmissions were 32 and total ADHF admissions were 214. Incidence of both 30 day and total ADHF readmissions were similar in all 3 BMI categories; ANOVA P=0.18 (30 day ADHF readmissions) and P= 0.62 (total ADHF readmissions). Obesity was neither associated with risk for 30 day readmission; OR=0.64 (CI: 0.20 - 2.0; P= 0.45) nor with the time to first ADHF readmission from the index hospitalization; log rank P=0.5 (Figure 1) Conclusions: Higher BMI is not protective against ADHF readmissions in patients with ADHF. Further studies are needed in larger data sets to validate our findings.

scholarly journals Utility of Complete Blood Picture for Predicting In-hospital Mortality in Patients with Acute Decompensated Heart Failure with Dilated Cardiomyopathy

2017 ◽  
Vol 02 (03) ◽  
pp. 044-048
Author(s):  
Dangeti Rao ◽  
Garre Indrani ◽  
M. RaviKiran
Keyword(s):  
Heart Failure ◽  
Hospital Mortality ◽  
Eosinophil Count ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Mean Corpuscular Hemoglobin ◽  
Index Hospitalization ◽  
Corpuscular Hemoglobin ◽  
Blood Picture ◽  
Group 1

Background Congestive heart failure (CHF) is one of the leading causes of acute hospital admissions. Despite recent advances in heart failure therapy, prognosis is still poor, rehospitalization rate is very high, and quality of life is worse. It is important to identify patients at increased risk of adverse events. We tried to investigate role of components of complete blood picture on in-hospital mortality in patients hospitalized with heart failure. Methods It was an observational study of consecutive patients who admitted with a diagnosis of acute decompensated heart failure (ADHF) with dilated cardiomyopathy (DCM) in the our department between January 1, 2016 and December 31, 2016, age above 18 years. Ischemic cardiomyopathy was ruled by doing coronary angiograms either in this admission or previously known. Baseline investigations including complete blood picture were done and the patients were followed up till discharge or in hospital mortality. Results A total of 74 patients (female:male::24:50) enrolled into the study (mean age 51.86 ± 13.5 years) in 12 months. A total of 8 (10.8%) patients died during hospitalization. Among the 74 heart failure patients, 24 (32.5%) had anemia. Group 1 included patients who died during index hospitalization (n = 8) and group 2 comprised patients who were discharged in a stable condition after index hospitalization (n = 66). Group 1 patients had low hemoglobin (12.34 ± 2.93 vs. 14.4 ± 0.21 g/dL, p = 0.000) and high leukocyte count (11,600 ± 2,780 vs. 9,047 ± 3,355 cells/mcL, p = 0.040) with more eosinophils (1 ± 1.06 vs. 4.16 ± 3.48%, p = 0.000) and lymphocytes (20.5 ± 0.53 vs. 17.56 ± 7.45%, p = 0.002). Regression analysis showed a significant association between low hemoglobin and low packed cell volume (PCV) with in-hospital mortality. Mean corpuscular hemoglobin (MCH) and mean corpuscular volume (MCV) rather than mean corpuscular hemoglobin concentration (MCHC) predicted worse outcome. There was a significantly higher risk of in-hospital mortality with increasing eosinophil count. On the other hand, there was no association between platelet count, total white blood cell (WBC) count, neutrophil, monocyte, or lymphocyte count with clinical outcome. Conclusion Low hemoglobin, low PCV, and high eosinophil count have been shown to predict in-hospital mortality. Complete blood picture can, therefore, be utilized in risk-stratifying patients with ADHF due to DCM.

scholarly journals Impact of polypharmacy on prognosis in patients with acute decompensated heart failure: from the CURE-HF registry

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Kanai ◽  
H Motoki ◽  
T Okano ◽  
K Kimura ◽  
M Minamisawa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Poor Prognosis ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Study Cohort ◽  
Cardiac Events ◽  
Ventricular Ejection Fraction ◽  
Funding Sources

Abstract Background Polypharmacy would be associated with poor prognosis in patients with heart failure (HF). Methods In 863 patients who discharged after treatment for HF were prospectively enrolled. Number of tablets prescribed at discharge was counted. Death, non-fatal myocardial infarction, non-fatal stroke, and hospitalization for HF were tracked. Results In our study cohort (median age, 78), 447 patients experienced adverse events during median 503 days follow-up. In Kaplan-Meier analysis, a greater number of prescribed tablets was associated with future adverse cardiac events in the crude population. Although patients with the greater number of non-HF medications showed worse outcome, those of HF medications were not associate with the outcome (Figure). Furthermore, the number of tablets was an independent predictor of future cardiovascular events after adjustment for age, gender, B-type natriuretic peptide, hemoglobin, albumin, estimated glomerular filtration rate, and left ventricular ejection fraction (HR 95% CI: 1.295 (1.066–1.573), p=0.009). Conclusions Polypharmacy was associated with poor prognosis. Although the numbers of tablets and non-HF medications were significantly associated with worse out come in HF patients, the number of HF medications was not. FUNDunding Acknowledgement Type of funding sources: None.

Abstract 206: An Obesity Paradox in Acute Decompensated Heart Failure

2014 ◽  
Vol 34 (suppl_1) ◽  
Author(s):  
Mahdi Khoshchehreh ◽  
Shaista Malik
Keyword(s):  
Heart Failure ◽  
Hospital Mortality ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Obesity Paradox ◽  
The United States ◽  
Hospitalized Patients ◽  
Hospital Death ◽  
Morbidly Obese ◽  
Obese Patients

Background: Prior studies on heart failure (HF) have shown that body mass index (BMI) is inversely associated with mortality. The aim of this study was to investigate the impact of morbid obesity (BMI > 40 kg/m2) on in-hospital mortality in patients presenting with Acute decompensated heart failure (ADHF). Methods: The Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project was analyzed for acute HF hospitalizations across the United States. A total number of 966,167 hospitalized patients with ADHF in 2009 were reviewed. Results: Morbidly obese patients constituted 13.4% of all patients with ADHF. Analysis of the unadjusted data revealed that morbidly obese patients compared with those not morbidly obese were less likely to die during hospitalization (OR 0.55, %95CI 0.53-0.57, P<0.0001). Cox proportional hazards regression was used to estimate the overall probability of in-hospital death with adjustments for age, sex, race, Elixhauser comorbidities, primary payer, hospital location, hospital teaching status, hospital bed-size, and total hospital admissions. The adjusted hazard of in-hospital death (HR 0.87, p< <.0001) indicates that there was statistically significant difference in the risk of in-hospital death associated with being morbidly obese. Conclusions: In this cohort of hospitalized patients with ADHF, higher BMI was associated with lower in-hospital mortality risk. The relationship between BMI and adverse outcomes in HF appears to be complex and consistent with the phenomenon of the “obesity paradox.”

Abstract P319: Racial Differences and Temporal Trends in Obesity Among Patients Hospitalized With Acute Decompensated Heart Failure With Preserved Ejection Fraction: The ARIC Study Community Surveillance

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Melissa C Caughey ◽  
Muthiah Vaduganathan ◽  
Sameer Arora ◽  
Arman Qamar ◽  
Robert J Mentz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Racial Differences ◽  
Acute Decompensated Heart Failure ◽  
Temporal Trends ◽  
Decompensated Heart Failure ◽  
Obesity Paradox ◽  
Black Patients ◽  
Aric Study ◽  
White Patients

Introduction: Obesity is disproportionately prevalent in black populations and strongly associated with heart failure with preserved ejection fraction (HFpEF). An “obesity paradox” or lower mortality risk with obesity, has been reported in HFpEF populations. Whether racial differences exist in the temporal trends and outcomes of obesity is uncertain. Methods: Hospitalizations for acute decompensated heart failure (ADHF) were sampled from 2005-2014 by the ARIC Study Community Surveillance and classified by physician review. BMI was calculated using the admission height and weight. Associations between obesity and 1-year all-cause mortality were analyzed with multivariable Cox regression. Results: There were 10,147 weighted hospitalizations for ADHF with ejection fraction ≥50% (64% female, 74% white). Overall, black patients had a higher mean BMI than white patients (34 vs. 30 kg/m 2 ; P <0.0001), and a greater prevalence of obesity (56% vs. 43%; P <0.0001). Mean BMI and obesity steadily increased from 2005-2014 for white patients (Trends: P = 0.003 and P = 0.002) while remaining stable for black patients. Within BMI groups (18.5-24, 25-30, 30-35, 35-40, and ≥40 kg/m 2 ) a U-shaped mortality risk was observed, with the lowest risk among patients with a BMI of 30-35 kg/m 2 ( Figure ). When defining obesity by a BMI cutpoint ≥30 kg/m 2 , the “obesity paradox” was apparent in 2005-2009 for white obese vs. non-obese patients (HR = 0.58, 95% CI: 0.38 - 0.80), but attenuated by 2010-2014 (HR = 1.11; 95% CI: 0.80 - 1.48); P for interaction =0.006. Among black patients, there was no survival benefit for a BMI ≥30 kg/m 2 in 2005-2009 (HR = 1.15; 95% CI; 0.65 - 2.02) or 2010-2014 (HR = 1.06; 95% CI: 0.68 - 1.66). Conclusion: In this decade-long community surveillance of HFpEF patients hospitalized with ADHF, obesity and mean BMI were stable for black patients but steadily increased for white patients. A BMI ≥30 kg/m 2 was initially associated with better survival among white patients but the association dissipated as obesity and mean BMI increased over time.

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