Pharmacologic Weight Loss for Heart Failure With Preserved Ejection Fraction: Getting to the Core of the Problem

2021 ◽  
Author(s):  
Daniel N. Silverman ◽  
Sheldon E. Litwin
Keyword(s):  
Heart Failure ◽  
Weight Loss ◽  
Ejection Fraction ◽  
Preserved Ejection Fraction ◽  
The Core

scholarly journals Weight loss early after discharge predicts the risk of rehospitalization in non-obese patients with heart failure preserved ejection fraction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Kamisaka ◽  
K Kamiya ◽  
K Iwatsu ◽  
N Iritani ◽  
Y Iida ◽  
...  
Keyword(s):  
Heart Failure ◽  
Weight Loss ◽  
Regression Analysis ◽  
Ejection Fraction ◽  
Associated Factors ◽  
Clinical Characteristics ◽  
Obese Patients ◽  
Preserved Ejection Fraction ◽  
Kaplan Meier ◽  
Worse Prognosis

Abstract Background Weight loss (WL) has been considered as a prognostic factor in heart failure with reduced ejection fraction (HFrEF). However, the prognosis and associated factors of WL in heart failure with preserved ejection fraction (HFpEF) have remained unclear. Purpose This study aimed to examine the prevalence, prognosis, and clinical characteristics of worse prognosis based on the identified WL after discharge in HFpEF. Methods The study was conducted as a part of a multicenter cohort study (Flagship). The cohort study enrolled ambulatory HF who hospitalized due to acute HF or exacerbation of chronic HF. Patients with severe cognitive, psychological disorders or readmitted within 6-month after discharge were excluded in the study. WL was defined as ≥5% weight loss in 6-month after discharge and HFpEF was defined as left ventricular ejection fraction (LVEF) ≥50% at discharge. Age, gender, etiology, prior HF hospitalization, New York Heart Association (NYHA) class, brain natriuretic peptide (BNP) or N-terminal-proBNP (NT-proBNP), anemia (hemoglobin; male <13g/dL, female <12g/dL), serum albumin, Geriatric Depression Scale, hand grip strength and comorbidities were collected at discharge. Patients were stratified according to their body mass index (BMI) at discharge as non-obese (BMI <25) or obese (BMI ≥25). We analyzed the association between WL and HF rehospitalization from 6 month to 2 years after discharge using Kaplan-Meier curve analysis and Cox regression analysis adjusted for age and gender, and clinical characteristics associated to worse prognosis in WL using logistic regression analysis adjusted for potential confounders in HFpEF. Results A total of 619 patients with HFpEF were included in the analysis. The prevalence of WL was 12.9% in 482 non-obese and 15.3% in 137 obese patients. During 2 years, 72 patients were readmitted for HF (non-obese: 48, obese: 24). WL in non-obese independently associated with poor prognosis (hazard ratio: 2.2: 95% confidence interval: 1.13–4.25) after adjustment for age and sex, while WL in obese patients did not. Logistic regression analysis chose age (odds ratio 1.02 per 1 year; 1.00–1.05), anemia (2.14; 1.32–3.48), and BNP ≥200pg/mL or NT-proBNP ≥900pg/mL (1.83; 1.18–2.86) as independent associated factors for worse prognosis of WL in non-obese patients. Conclusion In HFpEF, WL in early after discharge in non-obese elderly patients may be a prognostic indicator for HF rehospitalization. HF management including WL prevention along with controlling anemia is likely to improve prognosis in this population. Kaplan Meier survival curves Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): A Grant-in-Aid for Scientific Research (A) from the Japan Society for the Promotion of Science

scholarly journals Impact of weight loss in patients with heart failure with preserved ejection fraction: results from the FLAGSHIP study

2021 ◽  
Author(s):  
Kenta Kamisaka ◽  
Kuniyasu Kamiya ◽  
Kotaro Iwatsu ◽  
Naoki Iritani ◽  
Shota Imoto ◽  
...  
Keyword(s):  
Heart Failure ◽  
Weight Loss ◽  
Ejection Fraction ◽  
Preserved Ejection Fraction ◽  
Patients With Heart Failure

scholarly journals Weight Change and Mortality Risk in Heart Failure With Preserved Ejection Fraction

2021 ◽  
Vol 8 ◽  
Author(s):  
Peisen Huang ◽  
Zejun Guo ◽  
Weihao Liang ◽  
Yuzhong Wu ◽  
Jingjing Zhao ◽  
...  
Keyword(s):  
Heart Failure ◽  
Weight Loss ◽  
Weight Gain ◽  
Ejection Fraction ◽  
Mortality Risk ◽  
Weight Change ◽  
Preserved Ejection Fraction ◽  
Clinical Trial Registration ◽  
Risk Of Mortality ◽  
All Cause Mortality

Aims: The aim of the study was to determine the associations of weight loss or gain with all-cause mortality risk in heart failure with preserved ejection fraction (HFpEF).Methods and Results: Non-lean patients from the Americas from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist study were analyzed (n = 1,515). Weight loss and weight gain were defined as a decrease or increase in weight ≥5% between baseline and 1 year. To determine the associations of weight change and mortality risk, we used adjusted Cox proportional hazards models and restricted cubic spline models. The mean age was 71.5 (9.6) years. Weight loss and gain were witnessed in 19.3 and 15.9% patients, respectively. After multivariable adjustment, weight loss was associated with higher risk of mortality (HR 1.42, 95% CI 1.06–1.89, P = 0.002); weight gain had similar risk of mortality (HR 0.98, 95% CI 0.68–1.42, P = 0.932) compared with weight stability. There was linear relationship between weight change and mortality risk. The association of weight loss and mortality was different for patients with and without diabetes mellitus (interaction p = 0.009).Conclusion: Among patients with HFpEF, weight loss was independently associated with higher risk of all-cause mortality, and weight gain was not associated with better survival.Clinical Trial Registration:https://clinicaltrials.gov, Identifier: NCT00094302.

Abstract 15864: Measured versus Estimated Resting Metabolic Rate in Heart Failure With Preserved Ejection Fraction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Theresa Anderson ◽  
Thomas Cascino ◽  
Daniel Perry ◽  
Gillian Grafton ◽  
Todd M Koelling ◽  
...  
Keyword(s):  
Heart Failure ◽  
Weight Loss ◽  
Ejection Fraction ◽  
Metabolic Rate ◽  
Resting Metabolic Rate ◽  
World Health ◽  
Heart Catheterization ◽  
Preserved Ejection Fraction ◽  
Dietary Counseling ◽  
Metabolic Cart

Introduction: Obesity is common in heart failure with preserved ejection fraction (HFpEF) and dietary weight loss can improve functional capacity, but sarcopenia and frailty are also frequently present. Little evidence is available regarding resting metabolic rate (RMR) or how commonly used equations to estimate RMR compare to measured RMR in HFpEF. This information is vital for counseling patients on individual caloric needs. Hypothesis: Commonly used estimation equations do not accurately reflect measured RMR in patients with HFpEF. Methods: Resting metabolic rate (RMR) was measured with a metabolic cart for consecutive patients with HFpEF (EF ≥50%) referred for right heart catheterization at the University of Michigan from 2011-2015. Patients with congenital, infiltrative, hypertrophic, or restrictive cardiomyopathy were excluded. The RMR was calculated using the Weir formula: RMR= 1440*[3.94 VO 2 (l/min) + 1.11*VCO 2 (l/min)] kcal/day. Measured RMR and estimations of RMR using the Harris Benedict Equation (HBE), Mifflin-St Jeor Equation (MSJE), and World Health Organization (WHO) equation were compared using paired t-tests and Bland-Altman plots. Results: Patients (n=43) were aged (mean ± SD) 62 ± 11.6 years, 53% female, and BMI 34.9 ± 11. Mean measured RMR from Weir equation was 1514 ± 479 kcal/day. Estimated RMR by HBE was 1784 ± 530, MSJE was 1685 ± 457, and WHO equation was 1816.8 ± 485 kcal/day. All estimations significantly overestimated RMR when compared to the Weir method (>10% difference and p<0.01 for all; Figure A-C). The MSJE had the closest range of agreement to the measured RMR. Conclusions: Estimations of resting metabolic rate in patients with HFpEF demonstrated a fixed bias towards overestimation when compared to measured RMR by metabolic cart. Given HFpEF populations are often obese and are counseled routinely on weight loss, understanding the implicit bias of equations estimating RMR is vital when providing nutritional and dietary counseling.

scholarly journals Barriers to Weight Loss in a Heart Failure with Preserved Ejection Fraction Clinic

2019 ◽  
Vol 25 (8) ◽  
pp. S50
Author(s):  
Weihan Chen ◽  
Scott Hummel ◽  
Sonja Schuetz ◽  
Benjamin Palleiko ◽  
Taleen Shahrigian ◽  
...  
Keyword(s):  
Heart Failure ◽  
Weight Loss ◽  
Ejection Fraction ◽  
Preserved Ejection Fraction

Abstract 15762: Intensive Weight Management Improves Functional Capacity in Heart Failure With Preserved Ejection Fraction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Milad El Hajj ◽  
Elia El Hajj ◽  
Brandon Sykes ◽  
Renee Baxley ◽  
Melissa Lamicq ◽  
...  
Keyword(s):  
Heart Failure ◽  
Weight Loss ◽  
Body Weight ◽  
Ejection Fraction ◽  
Weight Management ◽  
Racial Differences ◽  
Management Program ◽  
Preserved Ejection Fraction ◽  
Primary Endpoints

Background: Obesity is associated with incident heart failure (HF), particularly HF with preserved ejection fraction (HFpEF). Weight loss is difficult to achieve in patients with limited physical capacity and the benefits remain uncertain in established HF. Methods: Patients with EF > 50% and at least 1 objective criteria for HFpEF (BNP 200 pg/ml, elevated resting or exercise wedge pressure (15 or 25 mmHg) or pulmonary edema on CXR) and BMI 30 kg/m2 were enrolled in a 15-week weight management program that entailed weekly counseling, weight checks, and meal replacement (twice daily weeks 1-8, once daily weeks 9-12). Primary endpoints were change from baseline to 15-weeks for weight, Minnesota Living With HF (MLWHF) score and 6 minute walk (6MW). Paired t-test was used to test for differences from baseline to the 15 week clinical endpoint, and one-way ANOVA was used to evaluate if these differences persisted at 26 week follow up. Results: 65 patients signed consent, 41 completed the 15-week program and 37 had 26-week follow up. Mean age was 67±9 years, BMI 41±6 kg/m 2 , 65% were female, and 43% black. Mean weight decreased by 8.1±6.6 kg at the 15-week endpoint (p<0.001) and persisted at 26-week follow up (p<0.001). 74% of patients lost more than 5% of their baseline body weight at week 15. Blacks lost a mean of 6±6% body weight compared to 9±4% in Caucasians (p<0.05). At 15 weeks, mean 6MW distance increased from 221±111 m to 286±99 m (p<0.001) and then fell to 275±144 m at 26 weeks (p=0.043). MLWHF score improved from 60±24 to 38±27 (p<0.001) and 38±26 (p<0.001) at 15 and 26 weeks, respectively. BNP did not change (109 to 114 pg/ml). E/e’ decreased significantly from 13.9±6.8 to 11.9±5.6 at 26 weeks follow up (p<0.01). BNP levels decreased by 39±103 pg/ml in blacks vs. an increase of 17±53 mg/dl in Caucasians (p<0.05) at 15-week follow up. Conclusions: Clinically relevant weight loss is possible in patients with established HFpEF and when it occurs, this is associated with significant improvements in quality of life and exercise capacity. There may be racial differences in the biochemical response to weight management in this population.

scholarly journals One case of severe obesity with preserved ejection fraction heart failure treated by permanent cardiac pacemaker

2020 ◽  
Author(s):  
Hong Kan ◽  
Jing Zhang ◽  
Xing Li ◽  
Cai Wu ◽  
Shuo Zhang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Weight Loss ◽  
Ejection Fraction ◽  
Atrioventricular Block ◽  
Severe Obesity ◽  
Cardiac Pacemaker ◽  
Left Ventricular ◽  
Preserved Ejection Fraction ◽  
Permanent Cardiac Pacemaker

A 54 year old male, with multiple diseases(such as severe obesity, severe edema, atrial fibrillation, high atrioventricular block, global enlargement (lA55mm LV 62mm RA 69*55mm RV 46mm)), was diagnosed as heart failure with preserved ejection fraction (HFpEF). After treatment with drugs and implanting permanent cardiac pacemaker, the patient’s edema completely disappeared, weight loss of 42kg, heart failure symptoms disappeared left ventricular shrinkage (LV 59mm).

scholarly journals Pragmatic Weight Management Program for Patients With Obesity and Heart Failure With Preserved Ejection Fraction

2021 ◽  
Author(s):  
Elia C. El Hajj ◽  
Milad C. El Hajj ◽  
Brandon Sykes ◽  
Melissa Lamicq ◽  
Michael R. Zile ◽  
...  
Keyword(s):  
Heart Failure ◽  
Body Mass Index ◽  
Weight Loss ◽  
Ejection Fraction ◽  
Management Program ◽  
Weight Management Program ◽  
Preserved Ejection Fraction ◽  
Walk Distance ◽  
Minute Walk Distance ◽  
Minute Walk

Background Obesity is associated with heart failure with preserved ejection fraction (HFpEF). Weight loss can improve exercise capacity in HFpEF. However, previously reported methods of weight loss are impractical for widespread clinical implementation. We tested the hypothesis that an intensive lifestyle modification program would lead to relevant weight loss and improvement in functional status in patients with HFpEF and obesity. Methods and Results Patients with ejection fraction >45%, at least 1 objective criteria for HFpEF, and body mass index ≥30 kg/m 2 were offered enrollment in an established 15‐week weight management program that included weekly visits for counseling, weight checks, and provision of meal replacements. At baseline, 15 weeks, and 26 weeks, Minnesota Living With Heart Failure score, 6‐minute walk distance, echocardiography, and laboratory variables were assessed. A total of 41 patients completed the study (mean body mass index, 40.8 kg/m 2 ), 74% of whom lost >5% of their baseline body weight following the 15‐week program. At 15 weeks, mean 6‐minute walk distance increased from 223 to 281 m ( P =0.001) and then decreased to 267 m at 26 weeks. Minnesota Living With Heart Failure score improved from 59.9 to 37.3 at 15 weeks ( P <0.001) and 37.06 at 26 weeks. Changes in weight correlated with change in Minnesota Living With Heart Failure score ( r =0.452; P =0.000) and 6‐minute walk distance ( r =−0.388; P <0.001). Conclusions In a diverse population of patients with obesity and HFpEF, clinically relevant weight loss can be achieved with a pragmatic 15‐week program. This is associated with significant improvements in quality of life and exercise capacity. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02911337.

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