Abstract P174: Factors Related to Decreased Readmission within 30 Days for Hispanic Heart Failure Patients

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Hong Seok Lee ◽  
Gerald Pekler ◽  
Fernand Visco ◽  
Savi Mushiyev
Keyword(s):  
Heart Failure ◽  
Readmission Rate ◽  
Central Obesity ◽  
Randomized Study ◽  
Obesity Paradox ◽  
Normal Weight ◽  
Obese Group ◽  
Heart Failure Patients ◽  
Number Of Patients ◽  
Heart Failure Exacerbation

Objective: This study was aimed to relate the obesity paradox to readmission and obesity. The obesity paradox remains controversial in the literature. Obesity has detrimental effects on heart failure, but has been found to be paradoxically associated with improved survival. We hypothesized that readmission in heart failure patients is associated with obesity. Method: We analyzed 732 patients who were admitted for heart failure exacerbation and enrolled in our heart failure program and excluded those who did not follow-up or patients discharged from the cardiology clinic. Patients who were readmitted within 30 days for heart failure exacerbation were investigated. 688 patients who have been followed since 2013 were included. BMI (body mass index) and WC (waist circumference) were classified according to NCEP-ATP III. Results: The number of normal weight (BMI <25kg/m 2 ), overweight (30 kg/m 2 >BMI≥25kg/m 2 ) and obesity (BMI≥30kg/m 2 ) were 35.7%, 35.1% and 29.1%, respectively. Central obesity (WC ≥94 cm for men ,and ≥80 for women) were 62%. The number of patients in our selected populations of HFrEF, HFpEF and HFpEF(i) were 456(67.9%),136(20.2%) and 68(11.9%) respectively. A higher readmission rate had a significantly associated with non-obese (BMI less than 30 kg/m 2) group compared to obese group(BMI more than 30 kg/m 2) in HFpEF patients. There was no significant association between central obesity and readmission. In addition, the absence of diabetes mellitus, an ICD (implantable cardioverter defibrillator), no prior cardiac catheterization and age over 65 were associated with a lower readmission rate. Conclusion: The obesity paradox with BMI applied to our study group. The obese group had a significant association with reduced readmission rate compared to the normal or overweight BMI group in HFpEF. WC was not associated with readmission. Higher BMI may be related to better cardiopulmonary fitness in HFpEF. To apply to clinical practice, a large randomized study should be warranted. Targeted management in different types of heart failure could be associated readmission.

scholarly journals The Obesity Paradox and Heart Failure: A Systematic Review of a Decade of Evidence

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Emmanuel Aja Oga ◽  
Olabimpe Ruth Eseyin
Keyword(s):  
Heart Failure ◽  
Weight Status ◽  
Obesity Paradox ◽  
Normal Weight ◽  
Conclusive Evidence ◽  
Study Endpoint ◽  
Nyha Classification ◽  
Improved Outcomes ◽  
Observational Cohort

There is scientific consensus that obesity increases the risk of cardiovascular diseases, including heart failure. However, among persons who already have heart failure, outcomes seem to be better in obese persons as compared with lean persons: this has been termed theobesity paradox, the mechanisms of which remain unclear. This study systematically reviewed the evidence of the relationship between heart failure mortality (and survival) and weight status. Search of the PubMed/MEDLINE and EMBASE databases was done according to the PRISMA protocol. The initial search identified 9879 potentially relevant papers, out of which ten studies met the inclusion criteria. One study was a randomized clinical trial and 9 were observational cohort studies: 6 prospective and 3 retrospective studies. All studies used the BMI, WC, or TSF as measure of body fatness and NYHA Classification of Heart Failure and had single outcomes, death, as study endpoint. All studies included in review were longitudinal studies. All ten studies reported improved outcomes for obese heart failure patients as compared with their normal weight counterparts; worse prognosis was demonstrated for extreme obesity (BMI>40 kg/m2). The findings of this review will be of significance in informing the practice of asking obese persons with heart failure to lose weight. However, any such recommendation on weight loss must be consequent upon more conclusive evidence on the mechanisms of the obesity paradox in heart failure and exclusion of collider bias.

scholarly journals Obesity Paradox" – another look at the problem of cardiovascular disease

2013 ◽  
Vol 10 (4) ◽  
pp. 3-9
Author(s):  
O V Shpagina ◽  
I Z Bondarenko
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Obesity Paradox ◽  
Developed Countries ◽  
Epidemiologic Studies ◽  
Normal Weight ◽  
Overweight And Obesity ◽  
Published Data ◽  
Risk Of Death ◽  
Cardiovascular Prognosis

Major epidemiologic studies over the last century demonstrated that obesity leads to several severe diseases such as diabetes mellitus, hypertension, coronary heart disease, chronic heart failure, cerebrovascular accidents. In developed countries cardiovascular diseases became the main cause of death. In the last 5–6 years some studies showed that people with overweight and obesity of the first degree have a higher life expectancy than people with normal weight. In 2009, the published data showed that the presence of obesity in patients with chronic heart failure does not impair cardiovascular prognosis. Overweight correlates with a decrease in overall mortality by 25%. And in a first degree of obesity the risk of death is reduced by 12%. This phenomenon is called "obesity paradox" and the causes of which are discussed in this review.

Obesity Paradox: Comparison of Heart Failure Patients With and Without Comorbid Diabetes

2017 ◽  
Vol 26 (2) ◽  
pp. 140-148 ◽  
Author(s):  
Kyoung Suk Lee ◽  
Debra K. Moser ◽  
Terry A. Lennie ◽  
Michele M. Pelter ◽  
Thomas Nesbitt ◽  
...  
Keyword(s):  
Heart Failure ◽  
Obesity Paradox ◽  
Heart Failure Patients

Abstract 325: Usefulness of Peripheral Vascular Disease Assessment on Readmission in a Heart Failure Program Cohort

2017 ◽  
Vol 37 (suppl_1) ◽  
Author(s):  
Hong Seok Lee ◽  
Gerald Pekler ◽  
Fernand Visco ◽  
Amrut Savadkar
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Functional Capacity ◽  
Readmission Rate ◽  
Ankle Brachial Index ◽  
Disease Assessment ◽  
Heart Failure Patients ◽  
Metabolic Equivalents ◽  
Significant Difference ◽  
Peripheral Arterial

Background: Peripheral arterial disease (PAD) was reported to have a relationship with functional capacity in heart failure patients. Heart failure patients presenting with a good functional capacity have been found to have better metabolic equivalents (METs). Recognizing and managing patients’ functional capacity surrogates like ankle-brachial index (ABI) and METs will be beneficial to improve the rate of readmission, however, little is known about the relationship with readmission rate in heart failure patients. We assessed readmission rate within 30 days after discharge using functional capacity assessment. Methods: 860 patients who were followed in the cardiology clinic from 2005 to 2015 were included. We analyzed the 240 patients who were admitted with a diagnosis of acute heart failure. Patients who were unable to cardiac rehabilitation or who had severe lung disease were excluded. Heart failure is classified as a reduced ejection fraction (HFrEF, EF <40) and preserved ejection fraction (HFpEF, EF>=50). MET (Metabolic equivalents) level was used for functional capacity. If ABI was less than 0.9 or over 1.4, patients were regarded to have peripheral arterial disease.We found no significant difference between our HFpEF and HFrEF patients (Mean METS 7.5±0.6 vs 7.4±0.7). ABI did not show any significant difference (1.1±0.2 vs 1.0±0.3). In multiple logistic regression analyses, HFpEF patients with more than 4 MET level were likely to have fewer readmissions rate compared to HFpEF patients with less than 4 METS level [odds ratio (OR): 0.54, confidence interval (CI): 0.35-0.81]. HFpEF patients with ABI between 0.9 and 1.4 had less readmission rate compared to HFpEF with less than 0.9 or more than 1.4 ABI [OR: 0.62, CI: 0.41-0.77] after related risk factors adjustment. Conclusion: In conclusion, good functional status with better METs and ABI in HFpEF patients was significantly associated with less readmission rate. ABI might be a surrogate factor for assessing functional capacity in HFpEF patients. This result implies that heart failure patients’ functional capacity might need to be assessed to decrease readmission rate.

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.

Abstract 2936: Obesity and Mortality in Patients with Heart Failure and Preserved Systolic Function

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
John R Kapoor ◽  
Paul A Heidenreich
Keyword(s):  
Heart Failure ◽  
Proportional Hazards ◽  
Systolic Function ◽  
Total Mortality ◽  
Obesity Paradox ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Heart Failure Patients ◽  
Objective Evidence

Several large cohort studies document better survival in heart failure patients with decreased left ventricular ejection fraction (EF) and higher body mass index (BMI) compared to those with a lower BMI. It is unclear, though, if this “obesity paradox” applies to heart failure patients with preserved EF or if it extends to the very obese (BMI>35). We followed 1,235 consecutive patients with a prior diagnosis of heart failure and a preserved EF (≥50%) documented on echocardiography at one of three laboratories. We determined adjusted mortality and readmission rates at 1 year following the echocardiogram. Obesity (BMI>30) was noted in 542 patients (44%). The mean age of the cohort was 71 years, but this varied depending on BMI (73 years for BMI<25, 64 years for BMI> 35, p< 0.001). In a subset of patients with complete diastolic indices and LV mass measurements (n=405), 95% had objective evidence of diastolic dysfunction. Age-adjusted all-cause mortality (Figure ) at one year decreased with increasing BMI (31% if BMI < 25, 22% if BMI 25–29, 20% if BMI 30–35 and 19% if BMI>35, p=0.003). In a proportional hazards analysis that adjusted for patient history, demographics and laboratory values, the hazard ratios for total mortality (relative to a normal BMI) were 1.47 (95% CI, 1.06–2.05) for BMI<25, 0.95 (95% CI, 0.64 –1.42) for BMI 30 –35, and 0.83 (95% CI, 0.52–1.31), for BMI >35, p=0.046). Similar findings were noted for the composite endpoint of survival free from heart failure hospitalization. These data suggest that the obesity paradox applies to heart failure patients with preserved systolic function and extends to very obese patients (BMI>35).

Evaluation of a Home-Based Intervention in Heart Failure Patients. Results of a Randomized Study

2005 ◽  
Vol 58 (6) ◽  
pp. 618-625 ◽  
Author(s):  
Cèsar Morcillo ◽  
José M. Valderas ◽  
Ofelia Aguado ◽  
Jordi Delás ◽  
Dolors Sort ◽  
...  
Keyword(s):  
Heart Failure ◽  
Randomized Study ◽  
Heart Failure Patients ◽  
Home Based ◽  
Home Based Intervention

CLINICAL CHARACTERISTICS OF OBESE AND NORMAL WEIGHT HEART FAILURE PATIENTS

CHEST Journal ◽  
2005 ◽  
Vol 128 (4) ◽  
pp. 291S
Author(s):  
Jun R. Chiong ◽  
Robert F. Percy ◽  
Binu Jacob ◽  
Hector P. Sanchez ◽  
Anabel C. Castro ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Characteristics ◽  
Normal Weight ◽  
Heart Failure Patients

Obesity and Cardioprotection

2020 ◽  
Vol 27 (2) ◽  
pp. 230-239 ◽  
Author(s):  
Saveria Femminò ◽  
Pasquale Pagliaro ◽  
Claudia Penna
Keyword(s):  
Heart Failure ◽  
Ischemia Reperfusion ◽  
Obesity Paradox ◽  
Obese Patients ◽  
Obesity And Diabetes ◽  
Patients With Heart Failure ◽  
Common Causes ◽  
Critical Issues ◽  
Inflammatory Processes ◽  
Heart Failure Exacerbation

The incidence of obesity and diabetes is increasing rapidly worldwide. Obesity and metabolic syndrome are strictly linked and represent the basis of different cardiovascular risk factors, including hypertension and inflammatory processes predisposing to ischemic heart disease, which represent the most common causes of heart failure. Recent advances in the understanding of ischemia/reperfusion mechanisms of injury and mechanisms of cardioprotection are briefly considered. Resistance to cardioprotection may be correlated with the severity of obesity. The observation that heart failure obese patients have a better clinical condition than lean heart failure patients is known as “obesity paradox”. It seems that obese patients with heart failure are younger, making age the most important confounder in some studies. Critical issues are represented by the &quot;obesity paradox” and heart failure exacerbation by inflammation. For heart failure exacerbation by inflammation, an important role is played by NLRP3 inflammasome, which is emerging as a possible target for heart failure condition. These critical issues in the field of obesity and cardiovascular diseases need more studies to ascertain which metabolic alterations are crucial for alleged beneficial and deleterious effects of obesity.

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