Impact of Obesity in Patients With Congestive Heart Failure

Pelberg, Robert; Mazur, Wojciech; Clarke, Gregory B.; Szawaluk, John

doi:10.3909/ricm0480

Cited by 11 publications

(5 citation statements)

References 208 publications

(111 reference statements)

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“…Interestingly, our study found significantly decreased risks of CHF, cardiac arrest, pneumonia, arrhythmia, and transfusion in obese patients compared to non-obese patients. This decrease in CHF, cardiac arrest, and arrhythmia could be explained by what is known as the “obesity paradox,” where BMI and mortality are inversely related [ 17 , 18 ]. This paradox theorizes that obesity may be protective and linked to higher survival rates in elderly and chronically ill populations.…”

Section: Discussionmentioning

confidence: 99%

“…Perhaps this is due to higher rates of CHF, pneumonia, and transfusion in non-obese patients during the first 90 days. Previous studies have found reduced mortality from CHF and pneumonia and decreased need for transfusion [ 17 , 24 , 25 ]. This decrease in mortality could reduce the amount of healthcare intervention required and, therefore, reduce the associated healthcare costs.…”

Section: Discussionmentioning

confidence: 99%

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The Impact of Obesity on Total Hip Arthroplasty Outcomes: A Retrospective Matched Cohort Study

Aggarwal¹,

Sambandam²,

Wukich³

2022

Cureus

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Previous research has shown that obesity is associated with worse postoperative outcomes. We aim to determine how rates of specific complications after total hip arthroplasty (THA) align with obesity status. We hypothesize that obese patients would have higher rates of complications and cost and thus have worse outcomes than non-obese patients. MethodsData were collected from a large commercial insurance database between 2011 and 2020. Patients underwent a hip replacement under current procedural terminology (CPT) and International Statistical Classification of Diseases (ICD-9/ICD-10) codes. Obese (defined as having a BMI of 30 kg/m 2 or higher) and non-obese patients were matched on age, gender, Charlson Comorbidity Index (CCI), and Elixhauser Comorbidity Index (ECI). Standardized complications and costs in one year were compared using unequal variance ttests. ResultsUnder CPT codes, 61,462 obese (45% male) and 61,462 non-obese patients (45% male) underwent a hip replacement. Obese patients had significantly higher rates of surgical site infection (SSI) (OR=1.193, p=0.0001), deep vein thrombosis (DVT) (OR=1.275, p=0.001), wound complication (OR=1.736, p<0.0001), hematoma (OR=1.242, p=0.0001), pulmonary embolism (OR=1.141, p=0.0355), UTI (OR=1.065, p=0.0016), and opioid prescriptions (OR=1.17, p<0.0001), and significantly lower rates of arrhythmia (OR=0.907, p<0.0001), congestive heart failure (CHF) (OR=0.863, p<0.0001), cardiac arrest (OR=0.637 p<0.0001), pneumonia (OR=0.795, p<0.0001), and transfusion (OR=0.777, p<0.0001). Furthermore, obese patients were significantly more likely to undergo revision within 10 years (OR=1.172, p<0.0001). Under ICD codes, 31,922 obese (45% male) and 31,922 non-obese patients (45% male) were included. Obese patients did not have a significant difference in total cost or drug cost. ConclusionsObese patients had significantly higher rates of infection, venous thromboembolic event, wound complication, hematoma, and opioid prescriptions but significantly lower rates of cardiac issues, pneumonia, and transfusion, after hip replacement. Additionally, there was no significant difference in total or drug cost. Therefore, this study did not support our hypothesis that obese patients have worse outcomes than non-obese patients, as there neither was a clear significant increase in complication rates nor a significant increase in costs. However, further research should be done to better understand the complex relationship between obesity and postoperative outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Impact of Obesity on Total Hip Arthroplasty Outcomes: A Retrospective Matched Cohort Study

Aggarwal¹,

Sambandam²,

Wukich³

2022

Cureus

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“…While this seems contradictory, other studies have found this same phenomenon called the "obesity paradox", where BMI and mortality are inversely related, and this could explain the decrease in odds of cardiac arrest and arrhythmia. 28,29 Even this paradox is controversial, however, because it could be due to retrospective data with obese patients being diagnosed earlier or due to a lack of proper adjustments for cardiorespiratory fitness as a high BMI due to fat and due to muscle are different. 30 Furthermore, patients in the non-obese group could have been obese previously, but then experienced illness related weight loss.…”

Section: Discussionmentioning

confidence: 99%

The impact of obesity on total knee arthroplasty outcomes: A retrospective matched cohort study

Aggarwal

Sambandam²,

Wukich³

2022

Journal of Clinical Orthopaedics and Trauma

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“…In contrast, other studies have described a paradoxical relation between a high BMI and the prognosis of patients with coronary artery disease and HF, called the obesity paradox ( 3 , 5 , 8 – 13 ). According to this theory, contrary to expectations, overweight or patients with obesity have a better prognosis in heart diseases when related to low or normal weight patients ( 3 , 8 , 9 , 12 , 14 ).…”

Section: Introductionmentioning

confidence: 78%

Is the obesity paradox in outpatients with heart failure reduced ejection fraction real?

Salvino,

Sousa,

Abrahao

et al. 2023

Front. Cardiovasc. Med.

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BackgroundThe obesity occurrence has achieved epidemic levels worldwide and several studies indicate a paradoxical similarity among obesity and the prognosis in heart failure (HF). The primary objective was to understand the association between body mass index (BMI) and heart failure with reduced ejection fraction (HFREF) of ischemic etiology in outpatients, using mortality as a parameter. The secondary objectives were to determine the differences in HF functional class, pharmacological therapy and evaluate the prognostic value of MAGGIC Score in this population.MethodsWe analyzed 1,556 medical records from the HF outpatient clinic of a quaternary hospital and 242 were selected according to the criteria. Most were male, average age 62.6 (56–70), BMI 18.5–24.9 = 35.1%, 25–29.9 = 37.2%, 30–34.9 = 17.8%, 35–39.9 = 7%; BMI <18.5 and >40 groups were eliminated from the central analyzes because of scarce testing.ResultsBMI 30–34.9 and BMI 18.5–24.9 had the best prognosis, BMI 25–29.9 had an average performance, and BMI –39.9 group provided the worst outcome (p = 0.123). In the subcategory analysis, BMI 30–34.9 group had a better prognosis compared to the BMI 35–39.9 group (p = 0.033). In the multivariate analysis The MAGGIC score was not able to foretell mortality in this population according to BMI.ConclusionIn not hospitalized patients with HFREF of ischemic etiology, obesity was not a protective factor.

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Impact of Obesity in Patients With Congestive Heart Failure

Cited by 11 publications

References 208 publications

The Impact of Obesity on Total Hip Arthroplasty Outcomes: A Retrospective Matched Cohort Study

The Impact of Obesity on Total Hip Arthroplasty Outcomes: A Retrospective Matched Cohort Study

The impact of obesity on total knee arthroplasty outcomes: A retrospective matched cohort study

Is the obesity paradox in outpatients with heart failure reduced ejection fraction real?

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