Author + information
- Received October 29, 2015
- Accepted December 1, 2015
- Published online March 1, 2016.
- Yuichi J. Shimada, MD, MPHa,∗ (, )
- Yusuke Tsugawa, MD, MPHb,
- David F.M. Brown, MDc and
- Kohei Hasegawa, MD, MPHc
- aCardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- bDepartment of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- cDepartment of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- ↵∗Reprint requests and correspondence:
Dr. Yuichi J. Shimada, Cardiology Division, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Gray/Bigelow 800, Mailstop 843, Boston, Massachusetts 02114.
Background The United States is battling obesity and heart failure (HF) epidemics. Although studies have suggested relationships between obesity and HF morbidity, little is known regarding the effects of substantial weight reduction in obese patients with HF.
Objectives This study investigated whether bariatric surgery is associated with a decreased rate of HF exacerbation.
Methods We performed a self-controlled case series study of obese patients with HF who underwent bariatric surgery, using the population-based emergency department (ED) and inpatient sample in California, Florida, and Nebraska. Primary outcome was ED visit or hospitalization for HF exacerbation from 2005 to 2011. We used conditional logistic regression to compare the outcome event rate during sequential 12-month periods, using pre-surgery months 13 to 24 as the reference period.
Results We identified 524 patients with HF who underwent bariatric surgery. During the reference period, 16.2% of patients had an ED visit or hospitalization for HF exacerbation. The rate remained unchanged in the subsequent 12-month pre-surgery period (15.3%; p = 0.67). In the first 12-month period after bariatric surgery, we observed a nonsignificantly reduced rate (12.0%; p = 0.052). However, the rate was significantly lower in the subsequent 13 to 24 months after bariatric surgery (9.9%; adjusted odds ratio: 0.57; p = 0.003). By contrast, there was no significant reduction in the rate of HF exacerbation among obese patients who underwent nonbariatric surgery (i.e., cholecystectomy, hysterectomy).
Conclusions Our findings indicate that bariatric surgery is associated with a decline in the rate of HF exacerbation requiring ED evaluation or hospitalization among obese patients with HF.
Dr. Shimada was supported, in part, by an unrestricted grant from the American Heart Association National Clinical and Population Research Award. Drs. Tsugawa and Shimada were supported, in part, by an unrestricted grant from Honjo International Scholarship Foundation. Dr. Tsugawa was supported, in part, by an unrestricted grant from St. Luke’s International University. The funding organizations did not have any role in the study design, analysis or interpretation of data, in writing of the report or in the decision to submit the paper for publication. The researchers were independent from the funding organizations. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Shimada and Tsugawa contributed equally to this work.
- Received October 29, 2015.
- Accepted December 1, 2015.
- American College of Cardiology Foundation