May 17, 2026Journal of the American College of Cardiology
The relationship between obesity and mortality in patients with heart failure
Key result
Obesity is not linked to increased mortality in advanced HF but trends toward improved survival.
- n=1,203
Why the study?
Previous reports link obesity to the development of HF, but the impact of obesity in patients with established HF had not been studied.
Does obesity increase mortality in patients with advanced heart failure?
Population
1,203 patients with advanced HF followed in a comprehensive HF management program
Comparison
Underweight vs recommended vs overweight vs obese BMI categories
Design
Cohort study
Authors
Discussion
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Implication
May not support aggressive weight loss in advanced HF; leaves open the obesity paradox for prospective validation.
Key Points
- This research evaluates how obesity affects prognosis in patients already diagnosed with heart failure.
- Analyzed 1,203 patients with advanced heart failure in a management program.
- Subclassified patients into BMI categories: underweight, recommended, overweight, and obese.
- Used survival analysis to compare one-year survival across BMI groups.
- Obesity was not linked to higher mortality rates; survival rates were similar across BMI groups.
- Obese and overweight groups had higher rates of hypertension and diabetes.
- Cardiopulmonary exercise tests and pulmonary capillary wedge pressure were strong predictors of survival.
Study Design
Type
Cohort (n=1,203)
Structured PICO
Does obesity increase mortality in patients with advanced heart failure?
P
Population
1,203 patients with advanced heart failure followed in a comprehensive HF management program, mean ejection fraction 0.22.
I
Intervention
Obesity and overweight body mass index (BMI > 27.8)
C
Comparator
Recommended BMI (20.7 to 27.7) and underweight BMI (<20.7)
O
Outcome
Survival / mortalityhard clinical
In patients with advanced heart failure, obesity is not associated with increased mortality and may confer a more favorable prognosis, supporting the concept of an obesity paradox in this population.
Cite This Study
Horwich et al. (2001) conducted a cohort in Advanced heart failure (n=1,203). Obesity (BMI >31) and Overweight (BMI 27.8-31) vs. Recommended BMI (20.7-27.7) and Underweight (BMI <20.7) was evaluated on Survival. Obesity (BMI >31) was not associated with increased mortality among 1,203 patients with advanced heart failure, but instead demonstrated a trend toward improved survival.