Prognostic Impact of Body Mass Index in Atrial Fibrillation

Abstract

Background/Objectives: Contradictory results have been reported regarding the influence of obesity on the prognosis of atrial fibrillation (AF). The present study aimed to explore the potential association of body mass index (BMI) with the clinical outcomes of hospitalized patients with AF. Methods: In this retrospective, post hoc analysis of the MISOAC-AF randomized trial, 1113 AF patients were included and stratified as the following: underweight (BMI < 18 kg/m²), normal weight (BMI 18-24.9 kg/m²), overweight (BMI 25-29.9 kg/m²), and obese (BMI ≥ 30 kg/m²). The primary outcome was all-cause mortality; the secondary composite outcome was any hospitalization related to AF, heart failure (HF), or stroke. Cox regression analysis, survival analysis, and spline curve models were utilized. Results: Of the patients (median age: 76 years (IQR: 13), male: 54.6%), the majority were overweight (41.4%), followed by obese (33%), normal weight (24%), and underweight (1.6%). During a median 31-month follow-up, 436 (39.2%) patients died and 657 (59%) were hospitalized due to AF, HF, or stroke. Underweight, overweight, and obesity groups were significantly associated with an increased risk of all-cause mortality (p-values 0.02, 0.001, and <0.001, respectively), while overweight and obesity were significantly associated with the composite endpoint (p-values 0.01, <0.001, respectively) compared to normal weight. The spline curve analyses yielded that BMIs > 26.3 and > 25 were incrementally associated with all-cause mortality and the composite endpoint, respectively. A J-shaped relationship between BMI and AF prognosis was deduced. Conclusions: In conclusion, in recently hospitalized AF patients, BMI values outside the normal range were independently associated with poorer prognosis; therefore, it is essential that AF patients maintain a normal weight.

Keywords: atrial fibrillation; body mass index; major cardiovascular events; obesity paradox.

Figure 1

Kaplan–Meier analysis on (a) all-cause mortality and (b) any hospitalization related to AF, HF, or stroke (AF = atrial fibrillation, HF = heart failure, BMI = body mass index).

Figure 2

Risk of primary (a) and secondary (b) outcomes according to BMI category (BMI = body mass index, 95% CI = 95% confidence interval). The normal-weight BMI category (BMI = 18–24.9) was used as reference (ref.) for all comparisons.

Figure 3

Cubic spline curve for the association between (a) BMI and all-cause death, (b) BMI and any hospitalization related to AF, HF, or stroke, (c) BMI and all-cause death after multivariate adjustment, and (d) BMI and any hospitalization related to AF, HF, or stroke after multivariate adjustment (BMI = body mass index, AF = atrial fibrillation, HF = heart failure).