Clinical research study
Weight and Mortality Following Heart Failure Hospitalization among Diabetic Patients

https://doi.org/10.1016/j.amjmed.2011.04.030Get rights and content

Abstract

Background

Type 2 diabetes is an important risk factor for heart failure and is common among patients with heart failure. The impact of weight on prognosis after hospitalization for acute heart failure among patients with diabetes is unknown. The objective of this study was to examine all-cause mortality in relation to weight status among patients with type 2 diabetes hospitalized for decompensated heart failure.

Methods

The Worcester Heart Failure Study included adults admitted with acute heart failure to all metropolitan Worcester medical centers in 1995 and 2000. The weight status of 1644 patients with diabetes (history of type 2 diabetes in medical record or admission serum glucose ≥200 mg/dL) was categorized using body mass index calculated from height and weight at admission. Survival status was ascertained at 1 and 5 years after hospital admission.

Results

Sixty-five percent of patients were overweight or obese and 3% were underweight. Underweight patients had 50% higher odds of all-cause mortality within 5 years of hospitalization for acute heart failure than normal weight patients. Class I and II obesity were associated with 20% and 40% lower odds of dying. Overweight and Class III obesity were not associated with mortality. Results were similar for mortality within 1 year of hospitalization for acute heart failure.

Conclusions

The mechanisms underlying the association between weight status and mortality are not fully understood. Additional research is needed to explore the effects of body composition, recent weight changes, and prognosis after hospitalization for heart failure among patients with diabetes.

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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    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.

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