The Impact of Body Mass Index on Morbidity and Mortality in Iraqi Patients With Heart Failure

BACKGROUND: Obesity and heart failure (HF) are increasingly significant contributors to illness and death worldwide. While obesity appears to increase the risk of HF, it may paradoxically improve survival. This study aimed to investigate the impact of body mass index (BMI) on the mortality and morbidity of patients with HF. METHODOLOGY: A total of 122 patients including females (n=39) and males (n=83) diagnosed with HF were admitted to two cardiac units in Basrah, Iraq. The diagnosis was made based on Framingham Heart Failure Diagnostic Criteria. The BMI, baseline hemodynamics, and medical history were recorded, while the etiology and severity of HF were assessed at enrollment. The patients were followed up prospectively for hospital admission, and survival after one year of enrollment. RESULTS: The mean age of patients with HF was 62.7 years (SD 10.25). They included based on BMI categories 49.2% of normal/underweight individuals, while 50.8% were overweight/obese. The most frequent etiology was ischemic heart disease in 63.9%. Echocardiography revealed that the prevalence of left ventricular ejection fraction (LVEF) < 50% was 62.29%. It was observed that obese/overweight patients were more likely to have diastolic HF (P=0.001), and more severe disease (P=0.014), and were more likely to be alive at the one-year mark (P=0.001) than underweight/normal ones. Furthermore, the underweight had the least favorable outcome than any of the other five BMI categories (P<0.0001). Moreover, obese/overweight individuals had higher hospitalization rates in the first six months than normal/underweight, though this was insignificant (P=0.15). CONCLUSIONS: It appears that among Iraqis with heart failure, those who are overweight or obese had better outcomes at one year compared to normal or underweight. Further studies on a larger number of HF patients, and utilizing additional anthropometric indices and cardiorespiratory fitness to validate the observation of this study are warranted.