Key result
Bariatric surgery significantly reduced the risk of new-onset atrial fibrillation by 29% (HR 0.71) and heart failure by 26% (HR 0.74) compared to other abdominal surgeries in obese patients.
Why the study?
Obesity is associated with higher incidence of AF, and weight reduction improves outcomes in known AF, but the effect of bariatric surgery versus other abdominal surgeries on incident HF or AF hospitalization was unclear.
Does bariatric surgery reduce the incidence of heart failure or first-time AF hospitalization in obese patients without known AF?
Cohort (n=4,743)
Does bariatric surgery reduce the incidence of heart failure or first-time AF hospitalization in obese patients without known AF?
Bariatric surgery in obese patients without known AF is associated with a reduced long-term risk of incident AF and heart failure hospitalizations, though with an increased risk of gastrointestinal bleeding.
Answers are grounded in this paper and cite their sources.
May support bariatric surgery to lower AF/HF risk in obesity; leaves open causal confirmation in RCTs.
BACKGROUND: Obesity is associated with a higher incidence of atrial fibrillation (AF). Weight reduction improves outcomes in patients known to have AF. OBJECTIVE: The purpose of this study was to compare the incidence of heart failure (HF) or first-time AF hospitalization in obese patients undergoing bariatric surgery (BAS) vs other abdominal surgeries. METHODS: A retrospective cohort study was conducted using linked hospital discharge records from 1994-2014. Obese patients without known AF or atrial flutter (AFL) who had undergone abdominal hernia or laparoscopic cholecystectomy surgery were identified for each case that underwent BAS (2:1). Clinical outcomes were HF, first-time hospitalization for AF, AFL, gastrointestinal bleeding (GIB), and ischemic or hemorrhagic stroke. Outcomes were analyzed using conditional proportional hazard modeling accounting for the competing risk of death, adjusting for demographics and comorbidities. RESULTS: VASc score 1.6 ± 1.2) with follow-up of 66 months. Compared to controls, BAS cases had a significantly lower risk of new-onset AF (hazard ratio [HR] 0.71; 95% confidence interval [CI] 0.54-0.93) or HF (HR 0.74; 95% CI 0.60-0.91) but a higher risk of GIB (HR 2.1; 95% CI 1.5-3.0), with no differences in AFL, ischemic stroke, or hemorrhagic stroke. Reduction in AF improved as follow-up increased beyond 60 months. CONCLUSION: In patients undergoing BAS, the risk of either HF or AF was reduced by ∼29% but with greater risk of GIB. The findings support the hypothesis that weight loss reduces the long-term risk of HF or incident AF hospitalization.
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Srivatsa et al. (2020) conducted a cohort in Obesity (n=4,743). Bariatric surgery vs. Other abdominal surgical procedures (laparoscopic cholecystectomy or abdominal hernia repair) was evaluated on New-onset atrial fibrillation (HR 0.71, 95% CI 0.54-0.93, p=0.01). Bariatric surgery significantly reduced the risk of new-onset atrial fibrillation by 29% (HR 0.71) and heart failure by 26% (HR 0.74) compared to other abdominal surgeries in obese patients.
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