Abstract
AIMS: In people with heart failure (HF), a high body mass index (BMI) has been linked with better outcomes ('obesity paradox'), but there is limited evidence in community populations across long-term follow-up. We aimed to examine the association between BMI and long-term survival in patients with HF in a large primary care cohort.
METHODS: We included patients with incident HF aged ≥45 years from the Clinical Practice Research Datalink (2000-2017). We used Kaplan-Meier curves, Cox regression and penalised spline methods to assess the association of pre-diagnostic BMI, based on WHO classification, with all-cause mortality.
RESULTS: There were 47 531 participants with HF (median age 78.0 years (IQR 70-84), 45.8% female, 79.0% white ethnicity, median BMI 27.1 (IQR 23.9-31.0)) and 25 013 (52.6%) died during follow-up. Compared with healthy weight, people with overweight (HR 0.78, 95% CI 0.75 to 0.81, risk difference (RD) -4.1%), obesity class I (HR 0.76, 95% CI 0.73 to 0.80, RD -4.5%) and class II (HR 0.76, 95% CI 0.71 to 0.81, RD -4.5%) were at decreased risk of death, whereas people with underweight were at increased risk (HR 1.59, 95% CI 1.45 to 1.75, RD 11.2%). In those underweight, this risk was greater among men than women (p value for interaction=0.02). Class III obesity was associated with increased risk of all-cause mortality compared with overweight (HR 1.23, 95% CI 1.17 to 1.29).
CONCLUSION: The U-shaped relationship between BMI and long-term all-cause mortality suggests a personalised approach to identifying optimal weight may be needed for patients with HF in primary care. Underweight people have the poorest prognosis and should be recognised as high-risk.
Original language | English |
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Pages (from-to) | 1542-1549 |
Number of pages | 8 |
Journal | Heart |
Volume | 109 |
Issue number | 20 |
Early online date | 8 Jun 2023 |
DOIs | |
Publication status | Published - 28 Sept 2023 |
Bibliographical note
© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.Acknowledgments
The SurviveHF protocol was approved by the Independent Scientific Advisory Committee to the Medicine and Healthcare products Regulatory Agency (protocol number 18_061R). This work uses data provided by patients and collected by the NHS as part of their care and support and would not have been possible without access to these data. The National Institute for Health Research recognises and values the role of patient data, securely accessed and stored, in underpinning and leading to improvements in research and care. HES and ONS data are subject to copyright (2018) and can be re-used with the permission of The Health and Social Care Information Centre. All rights reserved.
Keywords
- Male
- Humans
- Female
- Aged
- Overweight/complications
- Body Mass Index
- Thinness/complications
- Heart Failure
- Obesity/complications
- Risk Factors