Key result
Higher BMI in acute heart failure linked to ~7% lower in-hospital mortality and better functional status.
Why the study?
The impact of body mass index on activities of daily living and mortality in inpatients with acute heart failure was not well understood.
Does body mass index impact activities of daily living at discharge and hospital mortality in inpatients with acute heart failure?
Cohort (n=11,301)
Yes
Does body mass index impact activities of daily living at discharge and hospital mortality in inpatients with acute heart failure?
Overweight and obese inpatients with acute heart failure demonstrate greater independence in activities of daily living at discharge and lower mortality, supporting the obesity paradox.
Should not yet alter BMI management in acute HF; extends obesity paradox observations but requires prospective validation.
OBJECTIVES: To investigate the impact of body mass index on activities of daily living in inpatients with acute heart failure. DESIGN: A retrospective cohort study. SETTING: A hospital-based database contains Diagnosis Procedure Combination survey data from 100 participating acute-care hospitals. PARTICIPANTS: 11,301 inpatients aged 20 year or older who were admitted to the participating hospitals with a diagnosis of acute heart failure. MEASUREMENTS: The Barthel Index score at discharge and hospital death. RESULTS: The number of patients with a body mass index of <18.5 kg/m2 (underweight), 18.5-22.9 kg/m2 (low-normal weight), 23.0-24.9 kg/m2 (high-normal weight), 25.0-29.9 kg/m2 (overweight), and ≥30.0 kg/m2 (obesity) were 1689 (15%), 4715 (42%), 1809 (16%), 2306 (20%), and 782 (7%), respectively. Median Barthel Index scores at admission and discharge were 65 and 100, respectively. Hospital death occurred in 101 (0.9%) patients. Lower body mass index was associated with lower Barthel Index score at discharge and higher mortality. Multivariable analysis adjusted for body mass index, age, sex, New York Heart Association classification, Barthel Index score at admission, the updated Charlson Comorbidity Index, length of hospital stay, number of drugs administered, and rehabilitation during hospitalization revealed that body mass index was independently associated with Barthel Index score at discharge (beta: 0.354; 95% confidence interval: 0.248-0.461) and hospital death (odds ratio: 0.926, 95% confidence interval: 0.877-0.978). CONCLUSION: Overweight and obese inpatients showed greater independence in activities of daily living at discharge and lower rates of mortality, indicating the obesity paradox. A combination of rehabilitation and improved nutrition seems to be important in underweight patients with acute heart failure.
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Wakabayashi et al. (2018) conducted a cohort in Acute heart failure (n=11,301). Body mass index was evaluated on Barthel Index score at discharge and hospital death (OR 0.926, 95% CI 0.877-0.978). Higher body mass index in acute heart failure inpatients was independently associated with higher Barthel Index scores at discharge and lower hospital mortality (OR 0.926; 95% CI 0.877-0.978).
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