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Heart failure treatment in patients with and without obesity with an ejection fraction below 50

Yaar S Aga1,2, Sumant P Radhoe1, Dilan Aydin1

  • 1Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands.

European Journal of Clinical Investigation
|February 26, 2023
PubMed

Insights

Heart failure (HF) patients with obesity receive guideline-directed medical therapy (GDMT) more often and at higher doses than those without obesity. This includes key medications like beta-blockers, RAS-inhibitors, and MRAs.

Area of Science:

  • Cardiology
  • Obesity Medicine
  • Pharmacotherapy

Background:

  • Assessing heart failure (HF) treatment in patients with and without obesity is crucial for optimizing care.
  • Real-world data from Western European cohorts provide valuable insights into current treatment patterns.
  • Understanding disparities in HF management based on body mass index (BMI) is essential.

Purpose of the Study:

  • To evaluate and compare heart failure (HF) treatment strategies in patients with and without obesity.
  • To analyze the prescription rates and dosage of guideline-directed medical therapy (GDMT) across different BMI categories.
  • To identify factors associated with HF treatment adherence in obese versus non-obese patients.

Main Methods:

  • Utilized the CHECK-HF registry, including chronic HF patients (LVEF <50%) from 2013-2016 in Dutch clinics.
  • Categorized patients based on body mass index (BMI) and analyzed differences in HF medical treatment.
  • Performed multivariable logistic regression analysis, dichotomizing patients into BMI <30 kg/m² and ≥30 kg/m².

Main Results:

  • Included 7,671 patients; 16.7% had BMI ≥30 kg/m² and 8.1% had BMI ≥35 kg/m².
  • Obese patients were younger, with higher rates of comorbidities (diabetes, hypertension, OSAS).
  • Prescription rates and adherence to target doses of GDMT, particularly MRAs and diuretics, increased significantly with BMI.

Conclusions:

  • Guideline-recommended HF medications are more frequently prescribed to patients with obesity.
  • Obese HF patients are more likely to receive higher doses of key HF therapies, including beta-blockers, RAS-inhibitors, and MRAs.
  • These findings suggest a more aggressive approach to GDMT in obese HF patients within this cohort.
Abstract

Keywords:
guideline adherenceheart failureobesitypharmacotherapy

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