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Body mass index and outcomes of cardiac resynchronization with implantable cardioverter‐defibrillator therapy in older patients with heart failure
Author(s) -
EchouffoTcheugui Justin B.,
Masoudi Frederick A.,
Bao Haikun,
Curtis Jeptha P.,
Heidenreich Paul A.,
Fonarow Gregg C.
Publication year - 2019
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.1552
Subject(s) - medicine , cardiac resynchronization therapy , heart failure , implantable cardioverter defibrillator , cardiology , body mass index , ejection fraction
Aims To assess the association of body mass index (BMI) with heart failure (HF) outcomes after cardiac resynchronization therapy with defibrillator (CRT‐D) implantation. Methods and results Medicare beneficiaries with HF aged ≥ 65 years ( n = 18 922) undergoing first‐time CRT‐D from the National Cardiovascular Data Registry (NCDR) Implantable Cardioverter‐Defibrillator Registry between 2010 and 2013, were followed for 3 years post‐implantation. Survival curves and covariate adjusted hazard ratio (aHR) or odds ratio were used to assess the risks for death, readmission, and device‐related complications by BMI status. Of 18 922 HF patients receiving CRT‐D, 5265 (27.8%) were normal weight, 6896 (37%) were overweight, 6318 (33.4%) were obese, and 353 (1.8%) were underweight. Compared to those of normal weight (BMI 18.5–24.9 kg/m 2 ), underweight patients had a higher 3‐year post‐device implantation risk of death [aHR: 1.34 (95% confidence interval 1.09–1.65); P < 0.001] and of readmission [sub‐aHR: 1.25 (1.09–1.42); P < 0.001]. The corresponding 3‐year aHRs for death were 0.83 (0.77–0.89) for overweight, 0.74 (0.67–0.82) for obesity class I (BMI 30–34.9 kg/m 2 ), 0.78 (0.68–0.90) for obesity class II (BMI 35–39.9 kg/m 2 ), and 0.75 (0.60–0.93) for obesity class III (BMI ≥ 40 kg/m 2 , P for all categories < 0.001). Individuals with class III obesity had a higher risk of readmission [sub‐aHR: 1.17 (1.06–1.30)]. There were no differences in rates of device‐related complications within 90 days across BMI categories. Conclusion Most elderly patients with HF receiving CRT‐D were overweight or obese. While being underweight was associated with greater risks of death and hospitalization, overweight and obese patients were at lower risk of death after CRT‐D.