Obesity and Outcomes Following Cardiogenic Shock Requiring Acute Mechanical Circulatory Support

Abstract

Background: The association of obesity on outcomes in patients with cardiogenic shock requiring acute mechanical circulatory support has not been thoroughly investigated. Methods: We evaluated the National Readmission Database for adults with either acute myocardial infarction or heart failure complicated by cardiogenic shock requiring acute mechanical circulatory support between January 2016 and November 2017. Exposure was assessed using International Classification of Diseases , Tenth Revision codes for the degree of obesity with the reference being body mass index (BMI) of 20.0 to 29.9 group. Multiple logistic regression and Cox regression analysis were used to analyze in-hospital mortality and 30-day readmission, respectively. Results: The survey-weighted sample included a total of 35 555 hospitalizations with a mean age of 65.4±0.2 years and 29.8% females. Obesity was associated with higher in-hospital mortality (no obesity, 26.4% [BMI, 20.0–29.9] versus class I obesity, 25.0% [BMI, 30.0–34.9] versus class II obesity, 28.7% [BMI, 35.0–39.9] versus class III obesity, 34.9% [BMI, ≥40]; P <0.001). On stratified analysis, compared with a nonobese phenotype, younger adults (age <60) with class II and class III obesity (odds ratio, 1.9 [95% CI, 1.1–3.5], P =0.02; odds ratio, 2.1 [95% CI, 1.2–3.7], P =0.01) and older adults (age ≥60) with class III obesity (odds ratio, 1.7 [95% CI, 1.2–2.4], P =0.005) had higher mortality. There was no association between the degree of obesity and 30-day readmission. Conclusions: Among adults with acute myocardial infarction or acute heart failure resulting in cardiogenic shock requiring acute mechanical circulatory support, younger adults with class II and class III obesity and older patients with class III obesity have a higher risk of in-hospital mortality compared with nonobese patients.

Is There an Obesity Paradox in Cardiogenic Shock?

“…In their multivariate‐adjusted model, mortality was 37% lower in the men who were obese, but obesity did not affect mortality in women, with evidence of significant interaction ( P value for the association between BMI and sex 0.023). The results in the present study by Kwon et al 15 appear to differ from the recent publications, 13 , 14 which did not find an obesity paradox in CS. There are significant methodological differences between prior evaluations and the Kwon study that may shed light on these observations.…”

“… 11 , 12 Similarly, an obesity paradox has not been demonstrated in cardiogenic shock. Recently, Sreenivasan and colleagues 13 did not find an obesity paradox in a large US population of cardiogenic shock (CS) compared with those who were nonobese, and moderate and severe obesity had progressively higher mortality. 13 , 14 …”

Impact of the Obesity Paradox Between Sexes on In‐Hospital Mortality in Cardiogenic Shock: A Retrospective Cohort Study

“…Therefore, extrapolation of the results to a Western population, where a different definition for obesity is used, may be limited. Because the extremely obese in our study had the same BMI as obese individuals in Western countries, and worse outcomes were reported in the extremely obese group in previous studies, 14 , 30 , 31 , 32 further analysis with this group would have helped to better understand the effects of obesity; however, the number of patients in the extremely obese group was too small to have any statistical power (n=50). However, in a cubic spline curve drawn with BMI as a continuous variable, men with BMIs >30.0 kg/m 2 still showed significant lower ORs for mortality, so this might at least give a clue of what might have occurred had our population had a sufficient number of patients with higher BMI––although this is mere speculation and should be investigated in future larger studies.…”

Trends in 10-Year Predicted Risk of Cardiovascular Disease Associated With Food Insecurity, 2007–2016

“…The principal determinant of obesity and other cardiometabolic diseases is lifestyle, of which food habit is a main component ( 15 ). In our study, we found that the prevalence of obesity among FIS adults was higher compared to FS adults.…”