Gaps in obesity diagnosis and management among australians admitted with cardiovascular disease: a multi-centre audit

Background Obesity is a major modifiable predictor of cardiovascular disease. Addressing obesity has been shown to improve cardiovascular outcomes. Despite this, obesity remains inconsistently identified and suboptimally managed in routine cardiovascular care. Methods We conducted a retrospective audit of 500 consecutive inpatients admitted in 2025 for acute coronary syndrome (ACS), heart failure (HF) or atrial fibrillation (AF) across two tertiary Australian hospitals. Electronic medical records (EMR) were individually reviewed for documentation of overweight/obesity diagnosis, provision of lifestyle counselling, institution of pharmacological therapy, and referral for specialist weight management. The prevalence, documentation and treatment of other modifiable risk factors (i.e. hypertension, dyslipidaemia, smoking and diabetes) were also determined for comparison. Given low rates of BMI documentation in standard records, anthropometric measurements from echocardiography were used to validate the recorded prevalence of overweight/obesity. Results 391 ACS, 84 HF and 27 AF admissions were included in the study. Mean age was 66.7 ± 5.1 SD years with 40% being female sex and 9% of Aboriginal and Torres Strait Islander ethnicity. BMI by stratum was: <25kg/m2 = 32.2%; 25-29.9kg/m2 = 31.8%; ³30kg/m2 = 34.0%. Obesity was diagnosed or documented in 17%, and waist circumference wasn’t documented in any of the 500 medical records. In contrast hypertension, dyslipidaemia, smoking and diabetes were routinely identified and treated at much higher rates (figure). Obesity-specific management was uncommon: 13.3% were provided dietary advice, 2% were prescribed anti-obesity pharmacotherapy, 1.5% were referred to a dietician and no patients were referred to obesity services (Figure). Conclusion Overweight and obesity were highly prevalent, but rarely documented as a modifiable risk factor, and notably less frequently treated than other traditional risk factors. Systematic strategies are needed to increase obesity identification, improve BMI documentation and streamline obesity management in routine cardiovascular care.