Body mass and survival in patients with chronic heart failure without cachexia: the importance of obesity.
BACKGROUND
Cachexia in chronic heart failure carries a poor prognosis, but little is known about the influence of body mass on the prognosis of noncachectic heart failure patients.


METHODS
We studied 589 consecutive chronic heart failure patients followed for at least a year, in whom there were accurate baseline data for body mass.


RESULTS
Average age was 64.5 +/- 12.4 years, left ventricular ejection fraction (LVEF) 30.9 +/- 0.73%. Cachexia was present in 64. Noncachectic patients were divided into quintiles of body mass index (BMI), Q1 (BMI 22.2 +/- 1.5) to Q5 (BMI 34.1 +/- 2.8). There was no difference among the 5 groups in age, exercise capacity or LVEF. Survival was greatest in Q4 (1-year survival [95% confidence interval (CI)]) 0.91 (0.85-0.96) and 3-year survival 0.81 (0.73-0.89). Relative risks compared with Q4 were Q1: 2.3 (1.4-3.8); Q2: 1.7 (1.1-2.9); Q3: 1.8 (1.1-3.0); and Q5: 1.5 (0.9-2.5). In multivariate analysis of 1 year follow-up, peak oxygen consumption (hazard ratio with 95% CI) (0.89 [0.82-0.97]; P =.006), LVEF (0.94 [0.91-0.97]; P =.0002) and BMI (0.90 [0.82-0.98]; P =.02) independently predicted 1-year survival with a combined Chi;(2) value of 42.4. Age (1.01 [0.98-1.05] and diagnosis (1.56 [0.78-3.11]) was not a predictor of survival.


CONCLUSIONS
In patients with chronic heart failure, increasing BMI is not an adverse prognostic feature. Thinner patients appear to have a poorer prognosis.
Davos
Constantinos H
CH
Department of Cardiac Medicine, National Heart & Lung Institute, London, United Kingdom.
Doehner
Wolfram
W
Rauchhaus
Mathias
M
Cicoira
Mariantonietta
M
Francis
Darrel P
DP
Coats
Andrew J S
AJ
Clark
Andrew L
AL
Anker
Stefan D
SD
D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D000367:Age Factors; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology; D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology; D002100:Cachexia / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology*; D002908:Chronic Disease; D017079:Exercise Tolerance / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology*; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D010101:Oxygen Consumption / Q000502:physiology; D011237:Predictive Value of Tests; D012307:Risk Factors; D012720:Severity of Illness Index; D013223:Statistics as Topic; D013318:Stroke Volume / Q000502:physiology; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
D000318:Adrenergic beta-Agonists; D000806:Angiotensin-Converting Enzyme Inhibitors