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Prognosis of morbid obesity patients with advanced heart failure

Vijaiganesh Nagarajan1, Clay A Cauthen, Randall C Starling

  • 1Department of Hospital Medicine, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA.

Congestive Heart Failure (Greenwich, Conn.)
|August 6, 2013
PubMed

Insights

The obesity paradox may not apply to morbidly obese patients with advanced heart failure. Morbid obesity is linked to a higher risk of mortality and transplantation, challenging previous findings.

Area of Science:

  • Cardiology
  • Obesity Medicine

Background:

  • The obesity paradox suggests better outcomes for obese patients in certain conditions, including heart failure.
  • This study investigates whether this paradox holds true for individuals with morbid obesity and advanced heart failure.

Purpose of the Study:

  • To examine the relationship between body mass index (BMI) categories and prognosis in patients with advanced heart failure.
  • To determine if morbid obesity (BMI ≥40 kg/m²) is associated with worse outcomes compared to obesity (BMI 30.1-40 kg/m²) and non-obesity (BMI ≤30 kg/m²).

Main Methods:

  • A cohort of 501 consecutive patients with advanced heart failure undergoing heart transplant evaluation was analyzed.
  • Patients were stratified into three BMI groups: nonobese, obese, and morbidly obese.
  • Survival rates and risk of all-cause mortality/transplantation were compared across groups using univariate and multivariate analyses.

Main Results:

  • Unadjusted event-free survival rates were significantly lower in the morbidly obese group (28.6%) compared to obese (57.4%) and nonobese (48.4%) groups.
  • Both nonobese and morbidly obese patients faced a significantly higher risk of mortality/transplantation compared to the obese group, even after adjusting for confounding factors.
  • The morbidly obese group exhibited fewer cardiovascular risk factors, suggesting these factors may not explain the observed survival differences.

Conclusions:

  • The obesity paradox is present in advanced heart failure but does not extend to morbidly obese patients.
  • Morbid obesity is associated with a poorer prognosis in advanced heart failure, independent of traditional cardiovascular risk factors.
  • Clinical management strategies for advanced heart failure should consider the distinct risks associated with morbid obesity.

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