Obesity Is Associated with a Lower Risk of Mortality and Readmission in Heart Failure Patients with Diabetes

Objectives: We aim to investigate the relationship between body weight and the risk of cardiovascular events in heart failure patients with diabetes. Methods: We therefore conducted a retrospective analysis of HF patients with T2D using the Nationwide Readmissions Database (NRD) from 2016 to 2022. Patients were stratified by BMI classes: underweight, normal weight, overweight, and obesity classes I-III. The primary outcome was in-hospital mortality. Secondary outcomes included 1-year mortality and readmission for heart failure. Results: A total of 26,199 patients with BMI data were included in the analysis. Underweight patients had the highest risk of in-hospital mortality [aOR = 1.80 (95% CI: 1.16-2.80)] and cardiogenic shock [aOR = 2.13 (95% CI: 1.26-3.59)]. In contrast, obesity classes I-III were associated with significantly lower odds of those events. One-year mortality rates did not differ significantly across BMI groups. However, obesity classes II and III were associated with a lower adjusted risk of HF readmission [aHR = 0.71 (95% CI: 0.50-0.99); aHR = 0.68 (95% CI: 0.49-0.96), respectively]. Conclusions: In patients with T2D and HF, an obesity paradox exists whereby patients with obesity have a lower risk of in-hospital mortality and cardiogenic shock. Further, obesity classes II-III are associated with a lower risk of 1-year readmission for HF.