Recognition, diagnosis and management of obesity after myocardial infarction

Abstract

OBJECTIVE:We investigated the documentation of obesity as a medical problem, and subsequent management recommendations, in patients after myocardial infarction (MI). DESIGN: We performed a cross-sectional analysis of a randomly selected sample of 627 patients discharged after an MI, from five US teaching hospitals between 1/1/01 and 12/31/02. Information was extracted from clinical notes using standardized definitions. RESULTS: Mean body mass index (BMI) was 31713 kg/m 2 , which was documented in only 14% of patients and had to be calculated post hoc in the rest. Waist circumference and waist/hip ratio were not documented at all; 83% of patients were overweight, 55% obese, and 8% morbidly obese. In only 20% of patients with BMIZ30 kg/m 2 was the diagnosis of obesity documented either as a current medical problem, as part of past medical history or as a final diagnosis. A dietary counseling was carried out in 61% of patients with BMIZ25 kg/m 2 and in 61% of patients with BMIo25 kg/m 2 , P ¼ 0.96. Weight loss was described as part of the goals/plan at discharge in 7% of overweight and 9% of obese patients. There was no change in either the level of recognition of obesity (22 vs 19%, P ¼ 0.3) or in the proportion of obese patients for whom weight loss was described as part of the goals/plan at discharge (8 vs 10%, P ¼ 0.7) before (n ¼ 301) compared to after (n ¼ 326) the Call to Action in Obesity by the Surgeon General in December 2001. CONCLUSION: Obesity is underecognized, underdiagnosed and undertreated in persons with acute MI.

Targeting abdominal obesity in cardiology: Can we be effective?

“…From a clinical viewpoint, both indices should probably be assessed and may be useful to better define 'at risk' obesity because it was observed in the IDEA (International Day for the Evaluation of Abdominal obesity), which included 157,211 patients, that both WC and BMI were independently associated with the presence of CVD in both men and women (57). Nevertheless, with all the knowledge available in the literature regarding obesity and CVD, assessment and management of obesity following acute coronary syndrome is inadequate (58). …”

Attacking Obesity

“…We can be sure that we and every one of our patients know his or her body mass index (BMI). We don't do very well right now: in 1 study of patients after myocardial infarction, the BMI was documented in only 14% of patients (9). We can work with our own local cafeterias and state school systems to put systems in place similar to the one at the University of Virginia.…”

Obesity: A Risk Factor for Acute Myocardial Infarction with Angiographically Patent Epicardial Coronary Vessels in an Adolescent

“…Excess weight is associated with higher mortality and cardiovascular events [9] . About 10% of all patients with AMI and nearly 20% of those under 35 years of age do not have coronary atherosclerosis demonstrated by coronary angiography, necropsy or both.…”