Key result
A U-shaped relationship was observed where extreme BMI groups (<25 or ≥40 kg/m2) were associated with significantly higher in-hospital mortality compared to mild-to-moderate obesity (BMI 26-39 kg/m2) (OR 1.97).
Why the study?
While obesity is associated with elevated sudden cardiac death risk, studies evaluating its effect on outcomes in sudden cardiac death victims have yielded conflicting results.
Does a mildly to moderately elevated BMI improve in-hospital survival in patients admitted for out-of-hospital sudden cardiac death compared to normal/underweight or extreme obesity?
Cohort (n=2,330)
Yes
Does a mildly to moderately elevated BMI improve in-hospital survival in patients admitted for out-of-hospital sudden cardiac death compared to normal/underweight or extreme obesity?
This study demonstrates an 'obesity paradox' in out-of-hospital sudden cardiac death survivors, where mild to moderate obesity is associated with improved in-hospital survival compared to normal weight or extreme obesity.
While obesity has been shown to be associated with elevated risk for Sudden Cardiac Death (SCD), studies examining its effect on outcomes in SCD victims have shown conflicting results. We aimed to describe the body mass index (BMI) distribution in a nationwide cohort of patients admitted for an out of hospital SCD (OHSCD), and the relationship between BMI and in‐hospital mortality. We drew data from the U.S. National Inpatient Sample (NIS), to identify cases of OHSCD. Patients were divided into six groups based on their BMI (underweight, normal weight, overweight, obese I, obese II, extremely obese). Socio‐demographic and clinical data were collected, mortality and length of stay were analyzed. Multivariate analysis was performed to identify predictors of mortality. Among a weighted total of 2330 hospitalizations for OHSCD in patients with documented BMI, the mean age was 62.3 ± 29 years, 52.4% were male and 62% were white. The overall rate of in‐hospital mortality was 69.3%. A U‐shaped relationship between the BMI and mortality was documented, as patients with 25 < BMI < 40 exhibited significantly lower mortality (60.7%) compared to the other BMI groups (75.2%), p < .001. BMI of 25 kg/m 2 and below or 40 kg/m 2 and above, were independent predictors of in‐hospital mortality in a multivariate analysis along with prior history of congestive heart failure and Deyo Comorbidity Index of ≥2. A U‐shaped relationship between the BMI and in‐hospital mortality was documented in patients hospitalized for an out of hospital sudden cardiac death in the United States in the recent years.
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Rozen et al. (2021) conducted a cohort in Out-of-hospital sudden cardiac death (OHSCD) (n=2,330). Body mass index (BMI) <25 or ≥40 kg/m2 vs. Body mass index (BMI) 26-39 kg/m2 was evaluated on In-hospital mortality (OR 1.97, 95% CI 1.61-2.40, p=<.001). A U-shaped relationship was observed where extreme BMI groups (<25 or ≥40 kg/m2) were associated with significantly higher in-hospital mortality compared to mild-to-moderate obesity (BMI 26-39 kg/m2) (OR 1.97).
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