Safety and Effectiveness of Metabolic and Bariatric Procedures in Heart Failure: A Multicenter Retrospective Cohort Study

Objective This study examined the safety and effectiveness of metabolic and bariatric procedures (MBPs), including surgical and endoscopic interventions, among individuals with versus without heart failure (HF). Methods This multicenter retrospective cohort study (2021–2023) identified persons with HF who underwent MBPs at two medical centers. Thirty‐day safety events and changes in body weight and medication use were assessed. Results Of 1678 MBPs, 41 (2.4%) were performed in adults with HF (mean age, 51 ± 15 years; 66% female; mean BMI, 44 ± 7 kg/m 2 ). Despite older age and more obesity‐related complications, persons with HF did not appear to experience a higher risk of any safety event at 30 days versus those without HF (24% vs. 16%; adjusted OR, 1.64; 95% CI, 0.76–3.58; p = 0.21). Thirty‐day change in body weight was similar between those with (−5.9%; 95% CI, −6.9%, −4.9%) and without HF (−6.2%; 95% CI, −6.4%, −6.0%; p comparison = 0.57). By 1 year, individuals with HF experienced significant reductions in body weight (mean change, −18.7%; 95% CI, −22.1%, −15.3%; p < 0.001), cardiovascular ( p = 0.003) and glucose‐lowering medications ( p < 0.001), and loop diuretics ( p = 0.003). Conclusions These findings suggest that MBPs are safe and effective in well‐selected adults with obesity and HF. However, larger and prospective studies are warranted to enhance understanding of MBP risk/benefit in this population.