Key result
Black patients with HFpEF show ~30% higher obesity prevalence than white patients, though the gap narrows.
Why the study?
Obesity is disproportionately prevalent in black populations and associated with HFpEF, but whether racial differences exist in temporal obesity trends and outcomes among older HFpEF patients was unknown.
Are there racial differences in temporal trends and mortality outcomes associated with obesity among older patients with HFpEF?
Observational (n=10,147)
Yes
Are there racial differences in temporal trends and mortality outcomes associated with obesity among older patients with HFpEF?
Absolute Event Rate: 56% vs 43%
p-value: p=<0.0001
In older patients hospitalized with HFpEF, black patients have a disproportionately higher burden of obesity, but temporal increases in white patients are narrowing the gap, and class III obesity is associated with the worst survival in both races.
Obesity disparities in older HFpEF patients may warrant targeted assessment; leaves open whether narrowing racial gaps alter survival.
BACKGROUND/OBJECTIVES Obesity increases with age, is disproportionately prevalent in black populations, and is associated with heart failure with preserved ejection fraction (HFpEF). An “obesity paradox,” or improved survival with obesity, has been reported in patients with HFpEF. The aim of this study was to examine whether racial differences exist in the temporal trends and outcomes associated with obesity among older patients with HFpEF. DESIGN Community surveillance of acute decompensated heart failure (ADHF) hospitalizations, sampled by stratified design from 2005 to 2014. SETTING Atherosclerosis Risk in Communities Study (NC, MS, MD, MN). PARTICIPANTS A total of 10,147 weighted hospitalizations for ADHF (64% female, 74% white, mean age 77 years), with ejection fraction ≥50%. MEASUREMENTS ADHF classified by physician review, HFpEF defined by ejection fraction ≥50%. Body mass index (BMI) calculated from weight at hospital discharge. Obesity defined by BMI ≥30 kg/m 2 , class III obesity by BMI ≥40 kg/m 2 . RESULTS When aggregated across 2005–2014, the mean BMI was higher for black compared to white patients (34 vs 30 kg/m 2 ; P < .0001), as was prevalence of obesity (56% vs 43%; P < .0001) and class III obesity (24% vs 13%; P < .0001). Over time, the annual mean BMI and prevalence of class III obesity remained stable for black patients, but steadily increased for white patients, with annual rates statistically differing by race ( P ‐interaction = .04 and P = .03, respectively). For both races, a U‐shaped adjusted mortality risk was observed across BMI categories, with the highest risk among patients with a BMI ≥40 kg/m 2 . CONCLUSION Black patients were disproportionately burdened by obesity in this decade‐long community surveillance of older hospitalized patients with HFpEF. However, temporal increases in mean BMI and class III obesity prevalence among white patients narrowed the racial difference in recent years. For both races, the worst survival was observed with class III obesity. Effective strategies are needed to manage obesity in patients with HFpEF.
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Caughey et al. (2021) conducted an observational in Heart failure with preserved ejection fraction (HFpEF) (n=10,147). Black race vs. White race was evaluated on Prevalence of obesity (p=<0.0001). Black patients with HFpEF had a higher prevalence of obesity than white patients (56% vs 43%; P<0.0001), though temporal increases among white patients narrowed the racial difference over time.
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