Positive influence of being overweight/obese on long term survival in patients hospitalised due to acute heart failure.

• Main Authors: Simona Littnerova, Jiri Parenica, Jindrich Spinar, Jirí Vitovec, Ales Linhart, Petr Widimsky, Jiri Jarkovsky, Roman Miklik, Lenka Spinarova, Kamil Zeman, Jan Belohlavek, Filip Malek, Marian Felsoci, Jiri Kettner, Petr Ostadal, Cestmir Cihalik, Jiri Spac, Hikmet Al-Hiti, Marian Fedorco, Richard Fojt, Andreas Kruger, Josef Malek, Tereza Mikusová, Zdenek Monhart, Stanislava Bohacova, Lidka Pohludkova, Filip Rohac, Jan Vaclavik, Dagmar Vondrakova, Klaudia Vyskocilova, Miroslav Bambuch, Ladislav Dusek
• Format: Article
• Language: English
• Published: Public Library of Science (PLoS) 2015-01-01
• Series: PLoS ONE
• Online Access: https://doi.org/10.1371/journal.pone.0117142

BACKGROUND:Obesity is clearly associated with increased morbidity and mortality rates. However, in patients with acute heart failure (AHF), an increased BMI could represent a protective marker. Studies evaluating the "obesity paradox" on a large cohort with long-term follow-up are lacking. METHODS:Using the AHEAD database (a Czech multi-centre database of patients hospitalised due to AHF), 5057 patients were evaluated; patients with a BMI <18.5 kg/m2 were excluded. All-cause mortality was compared between groups with a BMI of 18.5-25 kg/m2 and with BMI >25 kg/m2. Data were adjusted by a propensity score for 11 parameters. RESULTS:In the balanced groups, the difference in 30-day mortality was not significant. The long-term mortality of patients with normal weight was higher than for those who were overweight/obese (HR, 1.36; 95% CI, 1.26-1.48; p<0.001)). In the balanced dataset, the pattern was similar (1.22; 1.09-1.39; p<0.001). A similar result was found in the balanced dataset of a subgroup of patients with de novo AHF (1.30; 1.11-1.52; p = 0.001), but only a trend in a balanced dataset of patients with acute decompensated heart failure. CONCLUSION:These data suggest significantly lower long-term mortality in overweight/obese patients with AHF. The results suggest that at present there is no evidence for weight reduction in overweight/obese patients with heart failure, and emphasize the importance of prevention of cardiac cachexia.