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Body mass index in acute heart failure: association with clinical profile, therapeutic management and in‐hospital outcome
Author(s) -
Parissis John,
Farmakis Dimitrios,
Kadoglou Nikolaos,
Ikonomidis Ignatios,
Fountoulaki Ekaterini,
Hatziagelaki Erifili,
Deftereos Spyridon,
Follath Ferenc,
Mebazaa Alexandre,
Lekakis John,
Filippatos Gerasimos
Publication year - 2016
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.489
Subject(s) - medicine , overweight , heart failure , body mass index , obesity paradox , diabetes mellitus , obesity , blood pressure , cardiology , endocrinology
Background Increased body mass index ( BMI ) is a risk factor for heart failure, but evidence regarding BMI in acute heart failure ( AHF ) remains inconclusive. We sought to compare the clinical profile, treatment and in‐hospital outcome across BMI categories in a large international AHF cohort. Methods The Acute Heart Failure Global Survey of Standard Treatment ( ALARM‐HF ) is a retrospective survey on 4953 patients admitted for AHF from nine countries in Europe, Latin America, and Australia. Patients with unavailable BMI data or BMI <18.5 kg/m 2 were excluded. Clinical data and in‐hospital mortality were compared among the following BMI categories: 18.5–24.9 kg/m 2 (normal weight), 25–29.9 kg/m 2 (overweight) and ≥30 kg/m 2 (obese). Results Overweight/obese patients represented 75.7% of patients and had worse New York Heart Association class ( P < 0.001) and higher admission systolic blood pressure ( P < 0.001). The prevalence of comorbidities increased in parallel with BMI and included arterial hypertension, diabetes mellitus, dyslipidaemia (all P < 0.001), chronic obstructive pulmonary disease ( P = 0.041) and chronic kidney disease ( P = 0.056). Use of guideline‐recommended medications also increased in parallel with BMI (angiotensin converting enzyme inhibitors/angiotensin II receptor blockers, P < 0.001; β‐blockers P < 0.001; mineralocorticoid receptors antagonist, P = 0.002). In‐hospital mortality had a U‐shaped relationship with BMI , with overweight patients having significantly lower rate (log‐rank P = 0.027); this relationship vanished after adjustment for confounders. Conclusions Overweight/obese patients represented the vast majority of AHF cases, had a higher prevalence of non‐cardiovascular comorbidities and were more likely to receive guideline‐recommended medications. The U‐shaped relationship between in‐hospital mortality and BMI may be explained by differences in clinical profile and treatment and not by an effect of body composition per se .