January 1, 2017Circulation JournalOpen Access

Effect of Obesity on the Prognostic Impact of Atrial Fibrillation in Heart Failure With Preserved Ejection Fraction

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Why the study?

Does the presence of atrial fibrillation worsen the composite outcome of all-cause death or readmission in obese versus non-obese patients with heart failure with preserved ejection fraction?

Population

1,497 analyzed patients hospitalized with acute decompensated heart failure according to Framingham…

Comparison

Presence of atrial fibrillation, flutter, or… vs Absence of atrial fibrillation on admission…

Design

Cohort

Follow-up

median 406 days (IQR, 116-739 days)

Authors

MYMayuko YagawaSakakibara Hospital YNYuji NagatomoHeart Failure / Cardiomyopathy YIYuki IzumiSakakibara Hospital

Discussion

Member takes

Implication

AF may warrant closer monitoring in non-obese HFpEF; leaves open BMI as effect modifier requiring prospective validation.

Structured PICO

Does the presence of atrial fibrillation worsen the composite outcome of all-cause death or readmission in obese versus non-obese patients with heart failure with preserved ejection fraction?

Population

1,497 analyzed patients (from 1,681 enrolled) hospitalized with acute decompensated heart failure (ADHF) according to Framingham criteria, excluding acute coronary syndrome. Mean age 71-75, 38% female, Japanese cohort (Tokyo). Stratified by BMI (low <18.5, medium 18.5-24.9, high ≥25) and LVEF (HFpEF ≥40%, HFrEF <40%).

Intervention

Presence of atrial fibrillation (AF), flutter, or atrial tachycardia detected on electrocardiogram at the time of hospital admission for ADHF.

Comparator

Absence of atrial fibrillation (non-AF) on admission electrocardiogram.

Outcome

Composite of all-cause death or readmission for acute decompensated heart failure.composite

Atrial fibrillation is an independent predictor of adverse clinical outcomes in non-obese patients with HFpEF, but this prognostic impact is blunted in obese patients or those with HFrEF.

Limitations

Cannot provide clues on the potential mechanism by which AF has a stronger impact on clinical outcome in low BMI patients
Cannot exclude the possibility that AF might be a marker of comorbidity (including older age) rather than a negative driver for it

Cite This Study

Yagawa et al. (2017) studied this question.

synapsesocial.com/papers/6a814a44176d2ce03166132d https://doi.org/10.1253/circj.cj-16-1130

Topics

HFrEF treatment Heart failure Atrial fibrillation Persistent AF management HFpEF management

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Effect of Obesity on the Prognostic Impact of Atrial Fibrillation in Heart Failure With Preserved Ejection Fraction

Discussion

Member takes

Implication

Structured PICO

Limitations

Cite This Study

Topics

Effect of Obesity on the Prognostic Impact of Atrial Fibrillation in Heart Failure With Preserved Ejection Fraction

Discussion

Member takes

Implication

Structured PICO

Limitations

Cite This Study

Also Consider

Topics

Also Consider