Key result
Intentional weight loss in heart failure with obesity improves NYHA class, exercise capacity, and quality of life.
Why the study?
Does intentional weight loss improve clinical symptoms, cardiac function, and quality of life in patients with heart failure and obesity?
Systematic Review
Does intentional weight loss improve clinical symptoms, cardiac function, and quality of life in patients with heart failure and obesity?
Intentional weight loss is feasible in patients with heart failure and obesity and may provide symptomatic and functional benefits, though definitive conclusions are hindered by the lack of large, high-quality trials.
Supports consideration of weight loss in obese HF; leaves open confirmation of benefits in large RCTs.
OBJECTIVE: Obesity is an independent risk factor for the development of heart failure, and the two commonly co-exist. The European Society of Cardiology does not provide guidance regarding weight loss strategies in heart failure. The aim of this study was to systematically review the evidence for outcomes following intentional weight loss in patients with heart failure and obesity. METHOD: A systematic review of English articles was undertaken using databases PubMed, Embase and CENTRAL. Randomized controlled trials and observational studies reporting outcomes following intentional weight loss by lifestyle, surgical or pharmacotherapy intervention in patients with obesity and heart failure were included. RESULTS: Four randomized controlled trials and seven observational studies were identified. Two randomized controlled trials used diet and exercise as an intervention, one used diet alone and one used a pharmacological intervention (orlistat). All but one reported significant weight loss. Two reported improvement in exercise capacity and quality of life. One reported improvement in New York Heart Association functional class in heart failure with preserved ejection fraction. The observational studies, five of which reported on outcomes following bariatric surgery, despite being small, heterogeneous and high risk of bias, suggested a trend in improvement of left ventricular function, quality of life and exercise capacity following weight loss. CONCLUSION: Weight loss is achievable with lifestyle intervention in those with heart failure and obesity and may result in improvements in New York Heart Association classification, quality of life and exercise capacity.
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McDowell et al. (2018) conducted a systematic review in Heart failure and obesity. Intentional weight loss interventions (lifestyle, pharmacotherapy, or bariatric surgery) vs. Control group (usual care, non-surgical, or no weight loss intervention) was evaluated on Changes in weight, left ventricular morphology/function, exercise capacity, NYHA classification, and quality of life. Intentional weight loss in patients with heart failure and obesity is achievable and may result in improvements in New York Heart Association functional classification, quality of life, and exercise capacity.
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