title: Body mass index, treatment practices, and mortality in patients with acute heart failure.
abstract: OBJECTIVE
  Obesity is associated with an increased risk of heart failure (HF). Among patients presenting with acute HF, however, differences in clinical characteristics, treatment regimens, and short-term prognosis of varying weights are largely unknown, particularly from a broader population-based perspective.
  
  
  METHODS
  A total of 3722 patients admitted with acute HF to 11 greater Worcester (Massachusetts, USA) hospitals during 1995 and 2000 were categorized as being lean (n = 216), normal weight (n = 1465), overweight (n = 1007), or obese (n = 1034) at the time of hospitalization.
  
  
  RESULTS
  Obese patients with decompensated HF were significantly younger (mean age = 71 years) compared with patients of normal weight (mean age = 79 years). Obese patients were more likely to have a history of diabetes and have previously undergone a percutaneous coronary intervention than patients of normal body weight. Lean patients (body mass index<18.5 kg/m2) were less likely to be treated with effective cardiac therapies than normal weight patients, whereas obese patients were more likely to be treated with diuretics. Obese patients experienced a significantly lower in-hospital (4.3 vs. 7.2%) and 30-day (7.3 vs. 14.5%) death rate than normal weight patients, whereas lean patients experienced the highest in-hospital (10.2%) and 30-day (19.9%) death rates.
  
  
  CONCLUSIONS
  The results of this study in residents of a large central New England metropolitan area suggest that obesity is associated with increased survival in patients with acute HF. Further assessment of the 'obesity paradox', and careful attention to patients with a low body mass index, in patients with decompensated HF is warranted.
authors.affiliation: Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA.
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Fitzgibbons
authors.forename: Olga T
authors.initials: OT
authors.lastname: Hardy
authors.forename: Darleen
authors.initials: D
authors.lastname: Lessard
authors.forename: Joel M
authors.initials: JM
authors.lastname: Gore
authors.forename: Jorge
authors.initials: J
authors.lastname: Yarzebski
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Goldberg
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D005260:Female; D006333:Heart Failure / Q000209:etiology* / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000401:mortality* / Q000503:physiopathology; D016017:Odds Ratio; D010818:Practice Patterns, Physicians'; D018570:Risk Assessment; D012307:Risk Factors; D013851:Thinness / Q000150:complications* / Q000401:mortality* / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome