WORSE OUTCOMES IN INDIVIDUALS WITH OBESITY UNDERGOING LEFT VENTRICULAR ASSIST DEVICE IMPLANTATION: A LONGITUDINAL INTERMACS STUDY

Abstract

Background The obesity and heart failure epidemics are growing, but there is little evidence of the outcomes in individuals with obesity (body mass index, BMI ≥30 kg/m2) following continuous-flow left ventricular assist device (CF-LAVD) implantation. Methods The Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) from 2008-2017 was utilized to identify patients who underwent CF-LVADs implantation. The cohort was stratified by pre-CF-LVAD implant BMI (<18.5 (underweight), ≥18.5-24.9 (normal), ≥25-29.9 (overweight), ≥30-34.9 (Class I obesity), ≥35 kg/m2 (Class II/III obesity)). Outcomes included all-cause and cardiovascular (CV) mortality and LVAD-associated complications. Adjusted subdistribution hazards ratio using the Fine-Gray model were adjusted for demographics, laboratory values, and comorbidities. Results We included 18,868 patients: 766 with a BMI <18.5, 5,186 with a normal BMI, 5,989 with a BMI ≥25-29.9, 4,018 with a BMI ≥30-34.9, and 2,909 with a BMI ≥35. Patients with a BMI ≥25 were younger, predominantly male, and Caucasian, but less so for a BMI ≥35. Individuals with a BMI ≥35 had a significantly higher risk of all-cause and CV mortality, as well as numerous LVAD-associated complications (Table 1). Conclusion After CF-LVAD implantation, individuals with obesity have an increased risk of mortality and associated complications, especially those with BMI ≥35. Further work is warranted to understand the cause of this risk. [Formula presented]