Abstract 14273: Obesity Paradox and Its Impact on Heart Failure With Preserved Ejection Fraction (HFpEF) in Geriatric Patients: A 2019 National Inpatient Analysis

Abstract

Introduction: Several studies have shown obesity to be inversely associated with mortality, the so-called obesity paradox. Although being a major cardiovascular risk factor, patients with morbid obesity are often excluded in HFpEF-related trials. Thus, we aim to evaluate the impact of obesity on major adverse cardiovascular and cerebrovascular events (MACCE) in Hospitalized Geriatric Patients with HFpEF. Methods: We queried the National Inpatient Sample (2019) to identify the geriatric admissions (age ≥65 years) with HFpEF. Comorbidities and outcomes were compared between obese and non-obese patients using relevant ICD-10 codes. Adjusted odds and independent predictors of MACCE with obesity were assessed by multivariable regression controlling for confounders. Results: Of 1743940 geriatric admissions with HFpEF, 430395 (24.7%) were obese [median age 75[70-80], female 63.1%, white 77.1%]. The obese cohort often consisted of relatively younger, female, black patients and had higher rates of obstructive sleep apnea (34.1% vs. 10.9%), diabetes (50.3% vs. 31.3%), hyperlipidemia (62.9% vs. 56.6%), chronic lung disease (48.2% vs 38.4%) and depression (17.3% vs. 13.4%) than non-obese (p<0.001). Comorbidities including hypertension (OR 2.00), peripheral vascular disease (OR 1.19), chronic kidney disease(OR 1.19) (p<0.001), and metastatic cancer (OR 1.20; p<0.019) were independent predictors for MACCE. The obese cohort had significantly lower adjusted odds (OR 0.82) of MACCE (Obesity Paradox) and all-cause mortality (2.9% vs. 4.6%) (p<0.001). They were more frequently discharged with prolonged hospital stays and higher hospital charges compared to non-obese (p<0.001). Conclusions: Obese geriatric HFpEF admissions have significantly lower odds of all-cause mortality and MACCE but higher comorbidity burden and healthcare utilization as compared to non-obese. Hypertension, metastatic cancer, CKD, and PVD were independent risk factors of MACCE.