Key result
Obesity is linked to ~83% higher 1-year HF readmission in HFrEF and HFmrEF, while underweight predicts mortality.
Why the study?
The prognostic value of body mass index in patients with HFmrEF and HFrEF remains unclear.
Does body mass index affect 1-year heart failure readmission and 5-year all-cause mortality in patients with HFrEF and HFmrEF?
Cohort (n=656)
Does body mass index affect 1-year heart failure readmission and 5-year all-cause mortality in patients with HFrEF and HFmrEF?
Hazard Ratio: 1.83 (95% CI 1.39–2.39)
p-value: p=<0.001
In patients with HFrEF and HFmrEF, higher BMI is associated with increased short-term HF readmission, whereas both underweight and obesity are associated with increased long-term all-cause mortality.
Supports BMI monitoring for readmission and mortality risk in HFrEF/HFmrEF; leaves open whether weight modification alters outcomes.
BACKGROUND: Obesity is closely related to cardiovascular outcomes. However, the prognostic value of body mass index (BMI) in patients with heart failure with mildly reduced ejection fraction (HFmrEF) and heart failure with reduced ejection fraction (HFrEF) remains unclear. OBJECTIVE: To investigate the association of BMI with 1-year heart failure readmission and 5-year all-cause mortality in patients with HFmrEF and HFrEF. METHODS: We consecutively enrolled patients hospitalized for HFrEF and HFmrEF between January 2018 and December 2020. Participants were categorized into underweight, normal weight, overweight, and obese groups by baseline BMI. Associations of BMI with readmission and mortality were analyzed using the Fine-Gray test, Cox proportional hazards model, and restricted cubic splines. RESULTS: Among 656 included patients, the readmission and mortality risk varied significantly across BMI groups (both Gray's test and log-rank P < 0.001). Compared to normal weight group, both overweight (sHR 1.60, 95% CI [1.24, 2.07]) and obese (sHR 1.83, 95% CI [1.39, 2.39]) groups showed significantly increased 1-year heart failure readmission risk. For 5-year all-cause mortality, the underweight (HR 2.30, 95% CI [1.62, 3.26]) and obese (HR 2.03, 95% CI [1.42, 2.91]) groups exhibited significantly higher risk. No significant interaction between BMI and heart failure phenotype was observed. Restricted cubic splines revealed a U-shaped relationship of BMI with mortality risk, but provided weak evidence on risk of readmission. CONCLUSION: BMI exerts divergent time- and outcome-dependent effects in HFrEF and HFmrEF. Obesity may be associated with short-term readmission risk, while underweight may be related to cachexia-associated long-term mortality.
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Peng et al. (2026) conducted a cohort in Heart failure with reduced and mildly reduced ejection fraction (HFrEF and HFmrEF) (n=656). Obesity vs. Normal weight was evaluated on 1-year heart failure readmission (sHR 1.83, 95% CI 1.39-2.39, p=<0.001). In patients with HFrEF and HFmrEF, obesity was associated with increased 1-year heart failure readmission (sHR 1.83; 95% CI 1.39-2.39), while underweight increased 5-year mortality.
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