Association of Obesity With Severity of Heart Failure Exacerbation: A Population-Based Study

Abstract

Background: Obesity and heart failure (HF) are important public health problems in the United States. Although studies have reported the association between obesity and higher chronic morbidity of HF, little is known about the relations of obesity with severity of HF exacerbation and in-hospital mortality; therefore, we aimed to investigate the associations of obesity with severity of HF exacerbation and in-hospital mortality.

Methods and results: This retrospective cohort study of adults hospitalized for HF exacerbation used population-based data sets (the State Inpatient Databases) of 7 US states from 2012 to 2013. The outcomes were acute severity measures-use of positive pressure ventilation and hospital length of stay-and in-hospital mortality. We determined the associations between obesity and these outcomes, including adjustment for sociodemographic factors and comorbidities. We identified 219 465 patients hospitalized for HF exacerbation. Of those, 37 539 (17.1%) were obese. Obese patients had a significantly higher risk of positive pressure ventilation use compared with nonobese patients (13.6% versus 8.8%), with a corresponding adjusted odds ratio of 1.61 (95% confidence interval, 1.55-1.68; P<0.001). Likewise, obese patients were more likely to have hospital length of stay of ≥4 days compared with nonobese patients (62.5% versus 56.7%), with an adjusted odds ratio of 1.40 (95% confidence interval, 1.37-1.44; P<0.001). In contrast, obese patients had significantly lower in-hospital mortality compared with nonobese patients (1.7% versus 3.3%), with an adjusted odds ratio of 0.87 (95% confidence interval, 0.80-0.95; P=0.002).

Conclusions: Based on large population-based data sets of patients with HF exacerbation, obesity was associated with higher acute severity measures but lower in-hospital mortality.

Keywords: acute severity; epidemiology; heart failure; obesity.

Figure 1

Unadjusted and adjusted associations of obesity with acute severity measures and in‐hospital mortality in patients hospitalized for heart failure exacerbation. Obesity was associated with a higher risk of positive pressure ventilation (PPV) use and longer hospital length of stay (LOS) compared with nonobesity. In contrast, obesity was associated with lower in‐hospital mortality compared with nonobesity. CI indicates confidence interval; IPPV, invasive positive pressure ventilation; NIPPV, noninvasive positive pressure ventilation; OR, odds ratio.