Body mass index and disease-modifying therapy in acute heart failure patients

Abstract

Objectives: Little is known about the impact of body mass index (BMI) on implementation of life saving therapies in patients hospitalized with acute heart failure (AHF) before admission and after stabilization. The present analysis was conducted to explore the relationship of BMI with drug prescription before hospital-ization and at discharge in AHF patients. Methods: ALARM-HF is an observational survey on hospitalized patients with AHF in 9 countries (6 European, Turkey, Mexico and Australia). The diagnosis and classification of AHF were based on the ESC guidelines. This subanalysis assesses differences in drug utilization on admission and at discharge in 3,924 AHF patients categorized by BMI in three groups: A <24.9 kg/m2 B 25-29.9 kg/m2 (normal/mild overweight) and C >30 kg/m2 (obese). Results: Most patients (65%) had a BMI > 25 kg/m2 (38% in group B and 27% obese). There was no difference in baseline left ventricular ejection fraction among groups. Patients in group B presented more frequently with systolic blood pressure >121 mmHg (A 16.7% vs B 21.8% vs C 16.9%, p <0.001) and were more likely to be treated with diuretics (A 9.2% vs B 11.3% vs C10.1%, p <0.001), ACEi (A 9.9% vs B 12.4% vs C 9.8%, p=0.002), ARBs (A 7.3% vs B 10.3% vs C 8.9%, p < 0.001), beta-blockers (A 6.8% vs B 9.7% vs C 6.8%, p=0.001), oral/TTS nitrates (A 2.3% vs B 3.5% vs C 2.6%, p =0.012), and digoxin (A 3.4% vs B 3.9% vs C 3.6%, p=0.024) on admission. Similarly at discharge, patients in group B patients were more likely to receive diuretics (A 20.6% vs B 26.6% vs C 19.7%, p <0.001), ACEi (A 19.5% vs B 24.0% vs C 17.5%, p=0.002), ARBs (A 13.8% vs B 19.7% vs C 15.2%, p<0.001), beta-blockers (A 10.4% vs B 14.4% vs C 11.2%, p <0.001), oral/TTS nitrates (A 6.4% vs B 8.6% vs C 6.1%, p =0.046) and tended to receive digoxin more frequently (A 7.3% vs B 8.2% vs C 6.8%, p=0.082). Use of calcium channel blockers did not differ among the various BMI groups both on admission and at discharge. Patients of group A well as obese patients (group C) had the greatest rate for all-cause in-hospital mortality whereas patients of group B had the lowest rate of adverse outcome (A 9.9% vs B 7.6% vs C 9.8%, p=0.049). Conclusion: In AHF patients, BMI affects the prescription of chronic medications before admission and at discharge. Normal/mild overweight patients have been treated more frequently with disease-modifying drugs, such as ACEi/ARBs and beta-blockers, which may be related with the favorable in-hospital outcome