Intentional weight loss in patients with obesity and heart failure is achievable and may improve NYHA classification, quality of life, and exercise capacity.
Systematic Review
Does intentional weight loss improve functional and clinical outcomes in patients with obesity and heart failure?
Intentional weight loss in patients with heart failure and obesity is achievable and may improve functional capacity and quality of life.
OBJECTIVE: Obesity is an independent risk factor for the development of heart failure, and the two commonly co-exist. The European Society of Cardiology does not provide guidance regarding weight loss strategies in heart failure. The aim of this study was to systematically review the evidence for outcomes following intentional weight loss in patients with heart failure and obesity. METHOD: A systematic review of English articles was undertaken using databases PubMed, Embase and CENTRAL. Randomized controlled trials and observational studies reporting outcomes following intentional weight loss by lifestyle, surgical or pharmacotherapy intervention in patients with obesity and heart failure were included. RESULTS: Four randomized controlled trials and seven observational studies were identified. Two randomized controlled trials used diet and exercise as an intervention, one used diet alone and one used a pharmacological intervention (orlistat). All but one reported significant weight loss. Two reported improvement in exercise capacity and quality of life. One reported improvement in New York Heart Association functional class in heart failure with preserved ejection fraction. The observational studies, five of which reported on outcomes following bariatric surgery, despite being small, heterogeneous and high risk of bias, suggested a trend in improvement of left ventricular function, quality of life and exercise capacity following weight loss. CONCLUSION: Weight loss is achievable with lifestyle intervention in those with heart failure and obesity and may result in improvements in New York Heart Association classification, quality of life and exercise capacity.
McDowell et al. (Fri,) conducted a systematic review in Obesity and heart failure. Intentional weight loss (lifestyle, surgical, or pharmacotherapy) was evaluated on Weight loss, exercise capacity, quality of life, New York Heart Association functional class, and left ventricular function. Intentional weight loss in patients with obesity and heart failure is achievable and may improve NYHA classification, quality of life, and exercise capacity.