The Relationship Between Body Mass Index and In-hospital Survival in Patients Admitted With Acute Heart Failure

Gabby Elbaz-Greener; Guy Rozen; Shemy Carasso; Merav Yarkoni; Harindra C Wijeysundera; Ronny Alcalai; Israel Gotsman; Eldad Rahamim; David Planer; Offer Amir

doi:10.3389/fcvm.2022.855525

The Relationship Between Body Mass Index and In-hospital Survival in Patients Admitted With Acute Heart Failure

Front Cardiovasc Med. 2022 Apr 28:9:855525. doi: 10.3389/fcvm.2022.855525. eCollection 2022.

Authors

Gabby Elbaz-Greener^{1

2}, Guy Rozen^{3

4

5}, Shemy Carasso^{6

7}, Merav Yarkoni^{1

2}, Harindra C Wijeysundera⁸, Ronny Alcalai^{1

2}, Israel Gotsman^{1

2}, Eldad Rahamim^{1

2}, David Planer^{1

2}, Offer Amir^{1

2

7}

Affiliations

¹ Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel.
² Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
³ Cardiology Division, Hillel Yaffe Medical Center, Hadera, Israel.
⁴ The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
⁵ Cardiology Division, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States.
⁶ Division of Cardiovascular Medicine, Baruch Padeh Medical Center, Poriya, Israel.
⁷ The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel.
⁸ Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.

Abstract

Background: The association between Body Mass Index (BMI) and clinical outcomes following acute heart failure (AHF) hospitalization is debated in the literature. Our objective was to study the real-world relationship between BMI and in-hospital mortality in patients who were admitted with AHF.

Methods: In this retrospective, multi-center study, we utilized the National Inpatient Sample (NIS) database to identify a sampled cohort of patients who were hospitalized with AHF between October 2015 and December 2016. Outcomes of interest included in-hospital mortality and length of stay (LOS). Patients were divided into 6 BMI (kg/m²) subgroups according to the World Health Organization (WHO) classification: (1) underweight ≤ 19, (2) normal weight 20-25, (3) overweight 26-30, (4) obese I 31-35, (5) obese II 36-39, and (6) extremely obese ≥40. A multivariable logistic regression model was used to identify predictors of in-hospital mortality and to identify predictors of LOS.

Results: A weighted total of 219,950 hospitalizations for AHF across the US were analyzed. The mean age was 66.3 ± 31.5 years and most patients (51.8%) were male. The crude data showed a non-linear complex relationship between BMI and AHF population outcomes. Patients with elevated BMI exhibited significantly lower in-hospital mortality compared to the underweight and normal weight study participants (5.5, 5,5, 2,8, 1.6, 1.4, 1.6% in groups by BMI ≤ 19, 20-25, 26-30, 31-35, 36-39, and, ≥40 respectively, p < 0.001) and shorter LOS. In the multivariable regression model, BMI subgroups of ≤ 25kg/m² were found to be independent predictors of in-hospital mortality. Age and several comorbidities, and also the Deyo Comorbidity Index, were found to be independent predictors of increased mortality in the study population.

Conclusion: A reverse J-shaped relationship between BMI and mortality was documented in patients hospitalized for AHF in the recent years confirming the "obesity paradox" in the real-world setting.

Keywords: AHF; BMI; acute heart failure; body mass index; outcome.