title: Body mass index in acute heart failure: association with clinical profile, therapeutic management and in-hospital outcome.
abstract: BACKGROUND
  Increased body mass index (BMI) is a risk factor for heart failure, but evidence regarding BMI in acute heart failure (AHF) remains inconclusive. We sought to compare the clinical profile, treatment and in-hospital outcome across BMI categories in a large international AHF cohort.
  
  
  METHODS
  The Acute Heart Failure Global Survey of Standard Treatment (ALARM-HF) is a retrospective survey on 4953 patients admitted for AHF from nine countries in Europe, Latin America, and Australia. Patients with unavailable BMI data or BMI <18.5 kg/m(2) were excluded. Clinical data and in-hospital mortality were compared among the following BMI categories: 18.5-24.9 kg/m(2) (normal weight), 25-29.9 kg/m(2) (overweight) and ≥30 kg/m(2) (obese).
  
  
  RESULTS
  Overweight/obese patients represented 75.7% of patients and had worse New York Heart Association class (P < 0.001) and higher admission systolic blood pressure (P < 0.001). The prevalence of comorbidities increased in parallel with BMI and included arterial hypertension, diabetes mellitus, dyslipidaemia (all P < 0.001), chronic obstructive pulmonary disease (P = 0.041) and chronic kidney disease (P = 0.056). Use of guideline-recommended medications also increased in parallel with BMI (angiotensin converting enzyme inhibitors/angiotensin II receptor blockers, P < 0.001; β-blockers P < 0.001; mineralocorticoid receptors antagonist, P = 0.002). In-hospital mortality had a U-shaped relationship with BMI, with overweight patients having significantly lower rate (log-rank P = 0.027); this relationship vanished after adjustment for confounders.
  
  
  CONCLUSIONS
  Overweight/obese patients represented the vast majority of AHF cases, had a higher prevalence of non-cardiovascular comorbidities and were more likely to receive guideline-recommended medications. The U-shaped relationship between in-hospital mortality and BMI may be explained by differences in clinical profile and treatment and not by an effect of body composition per se.
authors.affiliation: Heart Failure Unit, Department of Cardiology, Attikon University Hospital, 1 Rimini Street, 12462, Athens, Greece.
authors.forename: John
authors.initials: J
authors.lastname: Parissis
authors.affiliation: Heart Failure Unit, Department of Cardiology, Attikon University Hospital, 1 Rimini Street, 12462, Athens, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Farmakis
authors.affiliation: Heart Failure Unit, Department of Cardiology, Attikon University Hospital, 1 Rimini Street, 12462, Athens, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Kadoglou
authors.affiliation: Heart Failure Unit, Department of Cardiology, Attikon University Hospital, 1 Rimini Street, 12462, Athens, Greece.
authors.forename: Ignatios
authors.initials: I
authors.lastname: Ikonomidis
authors.affiliation: Heart Failure Unit, Department of Cardiology, Attikon University Hospital, 1 Rimini Street, 12462, Athens, Greece.
authors.forename: Ekaterini
authors.initials: E
authors.lastname: Fountoulaki
authors.affiliation: Heart Failure Unit, Department of Cardiology, Attikon University Hospital, 1 Rimini Street, 12462, Athens, Greece.
authors.forename: Erifili
authors.initials: E
authors.lastname: Hatziagelaki
authors.affiliation: Heart Failure Unit, Department of Cardiology, Attikon University Hospital, 1 Rimini Street, 12462, Athens, Greece.
authors.forename: Spyridon
authors.initials: S
authors.lastname: Deftereos
authors.affiliation: Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Ferenc
authors.initials: F
authors.lastname: Follath
authors.affiliation: Department of Anaesthesiology and Intensive Care, Lariboisière University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, Paris, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mebazaa
authors.affiliation: Heart Failure Unit, Department of Cardiology, Attikon University Hospital, 1 Rimini Street, 12462, Athens, Greece.
authors.forename: John
authors.initials: J
authors.lastname: Lekakis
authors.affiliation: Heart Failure Unit, Department of Cardiology, Attikon University Hospital, 1 Rimini Street, 12462, Athens, Greece.
authors.forename: Gerasimos
authors.initials: G
authors.lastname: Filippatos
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D050177:Overweight / Q000453:epidemiology*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Body mass index; Guideline-recommended therapies; Heart failure; Hospitalization; Mortality; Prognosis