title: Prevalence, Profile, and Prognosis of Severe Obesity in Contemporary Hospitalized Heart Failure Trial Populations.
abstract: This study evaluated the prevalence, profile, and prognosis of severe obesity in a large contemporary acute heart failure (AHF) population.
  
  
  
  Better prognosis has been reported for obese heart failure (HF) patients than nonobese HF patients, but in other cardiovascular populations, this effect has not been demonstrated for severely obese patients.
  
  
  
  A cohort of 795 participants with body mass index (BMI) measured at time of admission and complete follow-up were identified from enrollment in 3 contemporary AHF trials (DOSE [Diuretic Strategies Optimization Evaluation], CARRESS-HF [Cardiorenal Rescue Study in Acute Decompensated Heart Failure], and ROSE [Renal Optimization Strategies Evaluation in Acute Heart Failure]). Patients were divided into 4 BMI categories according to standard World Health Organization criteria, as follows: normal weight: 18.5 to 25 kg/m2[n = 128]; overweight: 25 to 29.9 kg/m2[n = 209]; mild-to-moderate obese: 30 to 39.9 kg/m2[n = 301]; and severely obese: ≥40 kg/m2[n = 157]). The relationship between BMI and 60-day composite outcome (death, rehospitalization, or unscheduled provider visit) was investigated.
  
  
  
  Patients with severe obesity (19.7%) were younger, more often female, hypertensive, diabetic, and more likely to have higher blood pressures and left ventricular ejection fraction, and lower N-terminal pro-B-type natriuretic peptide and troponin I levels than other BMI category patients. Following admission for AHF, patients with normal weight showed the highest risk of 60-day composite outcome, followed by patients who were severely obese. Overweight and mild-moderately obese patients showed lowest risk.
  
  
  
  Nearly one-fifth of AHF patients enrolled in contemporary randomized clinical trials are severely obese. A U-shaped curve for short-term prognosis according to BMI is seen in AHF. These findings may help to better inform both HF clinical care and future clinical trial planning.
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio. Electronic address: joycee@ccf.org.
authors.forename: Emer
authors.initials: E
authors.lastname: Joyce
authors.affiliation: Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York.
authors.forename: Anuradha
authors.initials: A
authors.lastname: Lala
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Susanna R
authors.initials: SR
authors.lastname: Stevens
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina; Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Lauren B
authors.initials: LB
authors.lastname: Cooper
authors.affiliation: Department of Medicine, Division of Cardiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Omar F
authors.initials: OF
authors.lastname: AbouEzzeddine
authors.affiliation: Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: John D
authors.initials: JD
authors.lastname: Groarke
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Justin L
authors.initials: JL
authors.lastname: Grodin
authors.affiliation: Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Eugene
authors.initials: E
authors.lastname: Braunwald
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Anstrom
authors.affiliation: Department of Medicine, Division of Cardiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Redfield
authors.affiliation: Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Lynne W
authors.initials: LW
authors.lastname: Stevenson
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D003920:Diabetes Mellitus / Q000453:epidemiology; D004311:Double-Blind Method; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D006760:Hospitalization; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D009765:Obesity / Q000453:epidemiology; D009767:Obesity, Morbid / Q000453:epidemiology*; D050177:Overweight / Q000453:epidemiology; D010446:Peptide Fragments / Q000097:blood; D015995:Prevalence; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D017678:Sex Distribution; D013318:Stroke Volume; D019210:Troponin I / Q000097:blood; D014481:United States / Q000453:epidemiology
chemical_list: D010446:Peptide Fragments; D019210:Troponin I; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: acute decompensated heart failure; obesity; prognosis; severe obesity