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Obesity is a risk factor for incident heart failure (HF) but does not increase mortality in established HF. We examined predictors of survival in normal weight (NW) vs obese (OB) HF patients.
We identified systolic HF patients in body mass index (BMI) cohorts 20.0-24.9 (NW) and 30.0-60.0 kg/m2 (OB). A multivariable Cox proportional hazard model examined associations between baseline demographics, metabolic stress results and all-cause mortality.
The NW cohort (n=1,097) had age 55.0±13.0, 31.1% females, and ejection fraction 21.0±8.9%; the OB cohort (n=1,469) was 51.7±10.9, 25.2% and 22.8±8.8% respectively (all p<0.002). Crude mortality was 41.3% (NW, 85.0 months) vs 37.8% (OB, 78.2 months), p=0.08. After adjustment for potential confounders (overall models χ2179.9 NW and 271.4 OB), VO2 max was highly predictive of mortality in both. In NW patients, age (χ240.9, see Figure 1), smoking (χ215.0) and β-blocker use (χ27.7), had the strongest mortality associations (all p≤0.02). In OB patients, exercise test duration (χ28.6, see Figure 2), decreasing systolic blood pressure (χ28.1), diabetes (χ26.1) and medications (χ2digoxin 22.0, ACE/ARB 11.2, ß-blocker 7.9) were strongest (all p≤0.02).
Beyond VO2 max, predictors of mortality differ in NW vs OB systolic HF cohorts. In NW patients, age has the strongest influence, but in the OB cohort features such as exercise duration, blood pressure and diabetes were stronger predictors of adjusted mortality beyond VO2 max.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Role of Comorbidities in Heart Failure: From Diabetes, Pulmonary Disease, Hypertension to Atrial Fibrillation
Abstract Category: 15. Heart Failure: Clinical
Presentation Number: 1263-289
- 2013 American College of Cardiology Foundation