Clinical research studyWeight and Mortality Following Heart Failure Hospitalization among Diabetic Patients
Section snippets
Methods
The Worcester Heart Failure Study included adult residents from the Worcester, MA metropolitan area (2000 census estimate = 478,000) hospitalized for possible heart failure at all 11 greater Worcester medical centers during 1995 and 2000.14, 15 The University of Massachusetts Medical School Institutional Review Board approved this study. The medical records of patients with primary or secondary International Classification of Disease-9 discharge diagnoses consistent with possible heart failure
Baseline Characteristics
The average age of our study population was 74 years, 57% were female, and 82% had been previously diagnosed with heart failure. Approximately one third (32.4%) of patients were of normal weight, 29.1% were overweight, and 35.6% were obese, including 18.1% with Class I obesity, 8.3% with Class II obesity, and 9.3% with Class III obesity. Only 47 patients (2.9%) were underweight. The majority of patients (n = 1444; 87.8%) had been previously diagnosed with diabetes, of which 43.6% had serum
Discussion
In this population-based study of residents of central Massachusetts, underweight patients had 50% higher odds of mortality by 5 years after hospital admission for decompensated heart failure than normal weight patients, and Class I and II obesity were associated with 20% and 40% lower odds of mortality. These results support previous studies that found an inverse or U-shaped relationship between weight and mortality in patients with heart failure.10, 11, 12, 20 To our knowledge, this study is
Conclusions
The results of this population-based investigation provide insights into the role of weight on 1- and 5-year mortality following hospitalization for decompensated heart failure among patients with diabetes. Underweight patients had 50% higher odds of mortality by 5 years than normal weight patients, and Class I and II obesity were associated with 20% and 40% lower odds of dying, respectively. The mechanisms underlying the observed association between weight and all-cause mortality are not fully
Acknowledgments
Grant support for this project was provided by the National Heart, Lung, and Blood Institute (R37 HL69874). Partial salary support for Drs Waring, Saczynski, McManus, Gore, and Goldberg is provided by the National Institutes of Health grant 1U01HL105268-01. This study was made possible by the cooperation of the administration, medical records, and cardiology departments of participating Worcester metropolitan area hospitals.
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2017, Nutrition Clinique et MetabolismeDischarge BNP is a stronger predictor of 6-month mortality in acute heart failure compared with baseline BNP and admission-to-discharge percentage BNP reduction
2016, International Journal of CardiologyCitation Excerpt :We have also shown previously that patients with extremely elevated admission BNP (BNP > 85th percentile, i.e. 1694 pg/mL) in the ESCAPE trial have higher 6-month all-cause mortality on multivariate analysis despite no significant differences in the degree of congestion and we attributed that to the characteristics of this group. Patients with extremely elevated admission BNP, had significantly lower cardiac output, older age, higher blood urea nitrogen and creatinine which were all found to be associated with post-discharge mortality in prior work [16–20]. With regards to the value of admission-to-discharge percentage BNP reduction, Di Somma and colleagues observed that at discharge, if a patient had BNP reduction > 46% relative to admission coupled with an absolute discharge BNP value < 300 pg/mL, they will have the least possibilities of adverse event in terms of cardiovascular death and rehospitalization [10].
Extremely elevated BNP in acute heart failure: Patient characteristics and outcomes
2016, International Journal of CardiologyCitation Excerpt :Prior studies demonstrated that elderly patients hospitalized with HF face a very grave prognosis, especially if their HF symptoms are caused by left ventricular systolic dysfunction [20]. Lower BMI [21], higher BUN [22,23], and higher creatinine [24] were also previously found to be independent predictors of mortality in acute decompensated HF. There are several limitations for this study.
Glucocentricity or adipocentricity: The unceasing quest for El Dorado
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2011, American Journal of MedicineGlycaemic control and insulin therapy are significant confounders of the obesity paradox in patients with heart failure and diabetes mellitus
2023, Clinical Research in Cardiology
Funding: Grant support for this project was provided by the National Heart, Lung, and Blood Institute (R37 HL69874). Partial salary support for Drs Waring, Saczynski, McManus, Gore, and Goldberg is provided by the National Institutes of Health grant 1U01HL105268-01.
Conflict of Interest: None of the authors have conflicts of interest to disclose.
Authorship: All authors had access to the data and a role in writing the manuscript.