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. 2015 Feb 24;10(2):e0117142.
doi: 10.1371/journal.pone.0117142. eCollection 2015.

Positive influence of being overweight/obese on long term survival in patients hospitalised due to acute heart failure

Simona Littnerova  1 , Jiri Parenica  2 , Jindrich Spinar  2 , Jirí Vitovec  3 , Ales Linhart  4 , Petr Widimsky  5 , Jiri Jarkovsky  1 , Roman Miklik  6 , Lenka Spinarova  3 , Kamil Zeman  7 , Jan Belohlavek  4 , Filip Malek  8 , Marian Felsoci  6 , Jiri Kettner  9 , Petr Ostadal  8 , Cestmir Cihalik  10 , Jiri Spac  11 , Hikmet Al-Hiti  9 , Marian Fedorco  10 , Richard Fojt  5 , Andreas Kruger  8 , Josef Malek  12 , Tereza Mikusová  13 , Zdenek Monhart  14 , Stanislava Bohacova  15 , Lidka Pohludkova  7 , Filip Rohac  5 , Jan Vaclavik  10 , Dagmar Vondrakova  8 , Klaudia Vyskocilova  13 , Miroslav Bambuch  15 , Ladislav Dusek  1
Affiliations

Positive influence of being overweight/obese on long term survival in patients hospitalised due to acute heart failure

Simona Littnerova et al. PLoS One. .

Abstract

Background: Obesity is clearly associated with increased morbidity and mortality rates. However, in patients with acute heart failure (AHF), an increased BMI could represent a protective marker. Studies evaluating the "obesity paradox" on a large cohort with long-term follow-up are lacking.

Methods: Using the AHEAD database (a Czech multi-centre database of patients hospitalised due to AHF), 5057 patients were evaluated; patients with a BMI <18.5 kg/m2 were excluded. All-cause mortality was compared between groups with a BMI of 18.5-25 kg/m2 and with BMI >25 kg/m2. Data were adjusted by a propensity score for 11 parameters.

Results: In the balanced groups, the difference in 30-day mortality was not significant. The long-term mortality of patients with normal weight was higher than for those who were overweight/obese (HR, 1.36; 95% CI, 1.26-1.48; p<0.001)). In the balanced dataset, the pattern was similar (1.22; 1.09-1.39; p<0.001). A similar result was found in the balanced dataset of a subgroup of patients with de novo AHF (1.30; 1.11-1.52; p = 0.001), but only a trend in a balanced dataset of patients with acute decompensated heart failure.

Conclusion: These data suggest significantly lower long-term mortality in overweight/obese patients with AHF. The results suggest that at present there is no evidence for weight reduction in overweight/obese patients with heart failure, and emphasize the importance of prevention of cardiac cachexia.

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Conflict of interest statement

Competing Interests: The authors have declared that no competiting interests exist.

Figures

Fig 1
Fig 1. Definition of datasets.
Fig 2
Fig 2. Thirty-day mortality according to BMI category.
Fig 3
Fig 3. Absolute standardized differences (%) in observed covariates between patients with normal weight and those who were overweight/obese before and after matching of propensity score (age, diastolic blood pressure, heart rate, width of QRS interval, atrial fibrillation, hypertension, type-2 diabetes mellitus, coronary artery disease, creatinine level and haemoglobin level).
Covariates with a post-match absolute standardized difference <10% were considered successfully balanced.
Fig 4
Fig 4. Thirty-day mortality according to the BMI category and type of heart failure.
Fig 5
Fig 5. Long-term mortality for all patients according to a BMI of 25 kg/m2 in a non-balanced and balanced dataset and for ADHF and de novo AHF patients.
See this image and copyright information in PMC

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