Body mass index and outcomes of cardiac resynchronization with implantable cardioverter‐defibrillator therapy in older patients with heart failure. (29th July 2019)

• Record Type: Journal Article
• Authors: Echouffo‐Tcheugui, Justin B.; Masoudi, Frederick A.; Bao, Haikun; Curtis, Jeptha P.; Heidenreich, Paul A.; Fonarow, Gregg C.
• Is Part Of: European journal of heart failure. Volume 21:Number 9(2019)
• Page Start: 1093
• Page End: 1102
• Publication Date: 2019-07-29
• Subjects: Cardiac resynchronization therapy -- Implantable cardioverter‐defibrillator -- Body mass index -- Heart failure -- Outcomes; Heart failure -- Periodicals; Heart Failure -- Periodicals; Insuffisance cardiaque -- Périodiques; Heart failure; Periodicals; 616.129005
• DOI: 10.1002/ejhf.1552
• Languages: English
• ISSNs: 1388-9842

Abstract

Abstract : Aims: To assess the association of body mass index (BMI) with heart failure (HF) outcomes after cardiac resynchronization therapy with defibrillator (CRT‐D) implantation. Methods and results: Medicare beneficiaries with HF aged ≥ 65 years ( n = 18 922) undergoing first‐time CRT‐D from the National Cardiovascular Data Registry (NCDR) Implantable Cardioverter‐Defibrillator Registry between 2010 and 2013, were followed for 3 years post‐implantation. Survival curves and covariate adjusted hazard ratio (aHR) or odds ratio were used to assess the risks for death, readmission, and device‐related complications by BMI status. Of 18 922 HF patients receiving CRT‐D, 5265 (27.8%) were normal weight, 6896 (37%) were overweight, 6318 (33.4%) were obese, and 353 (1.8%) were underweight. Compared to those of normal weight (BMI 18.5–24.9 kg/m 2 ), underweight patients had a higher 3‐year post‐device implantation risk of death [aHR: 1.34 (95% confidence interval 1.09–1.65); P < 0.001] and of readmission [sub‐aHR: 1.25 (1.09–1.42); P < 0.001]. The corresponding 3‐year aHRs for death were 0.83 (0.77–0.89) for overweight, 0.74 (0.67–0.82) for obesity class I (BMI 30–34.9 kg/m 2 ), 0.78 (0.68–0.90) for obesity class II (BMI 35–39.9 kg/m 2 ), and 0.75 (0.60–0.93) for obesity class III (BMI ≥ 40 kg/m 2, P for all categories < 0.001). Individuals with class III obesity had a higher risk of readmission [sub‐aHR: 1.17 (1.06–1.30)]. There were no differences in rates of device‐related complications within 90 days across BMI categories. Conclusion: Most elderly patients with HF receiving CRT‐D were overweight or obese. While being underweight was associated with greater risks of death and hospitalization, overweight and obese patients were at lower risk of death after CRT‐D.