TY - JOUR
T1 - Body mass index and outcomes of cardiac resynchronization with implantable cardioverter-defibrillator therapy in older patients with heart failure
AU - Echouffo-Tcheugui, Justin B.
AU - Masoudi, Frederick A.
AU - Bao, Haikun
AU - Curtis, Jeptha P.
AU - Heidenreich, Paul A.
AU - Fonarow, Gregg C.
N1 - Funding Information:
The Implantable Cardioverter-Defibrillator Registry is an initiative of the American College of Cardiology Foundation with partnering support from the Heart Rhythm Society. Conflict of interest: F.A.M. has a contract with the American College of Cardiology as the Chief Science Officer of the NCDR. J.P.C. has a contract with the American College of Cardiology for his role as Senior Medical Officer, NCDR; receives salary support from the American College of Cardiology, NCDR; receives funding from the Centers for Medicare & Medicaid Services to develop and maintain performance measures that are used for public reporting; and holds equity interest in Medtronic. G.C.F. reports significant consulting for Novartis, and modest consulting for Amgen, Bayer, Gambro, Medtronic, and Janssen, and research funding from AHRQ and NHLBI; holds the Eliot Corday Chair of Cardiovascular Medicine at UCLA and is also supported by the Ahmanson Foundation (Los Angeles, California). All other authors have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2019 The Authors. European Journal of Heart Failure © 2019 European Society of Cardiology
PY - 2019/9/1
Y1 - 2019/9/1
N2 - Aims: To assess the association of body mass index (BMI) with heart failure (HF) outcomes after cardiac resynchronization therapy with defibrillator (CRT-D) implantation. Methods and results: Medicare beneficiaries with HF aged ≥ 65 years (n = 18 922) undergoing first-time CRT-D from the National Cardiovascular Data Registry (NCDR) Implantable Cardioverter-Defibrillator Registry between 2010 and 2013, were followed for 3 years post-implantation. Survival curves and covariate adjusted hazard ratio (aHR) or odds ratio were used to assess the risks for death, readmission, and device-related complications by BMI status. Of 18 922 HF patients receiving CRT-D, 5265 (27.8%) were normal weight, 6896 (37%) were overweight, 6318 (33.4%) were obese, and 353 (1.8%) were underweight. Compared to those of normal weight (BMI 18.5–24.9 kg/m2), underweight patients had a higher 3-year post-device implantation risk of death [aHR: 1.34 (95% confidence interval 1.09–1.65); P < 0.001] and of readmission [sub-aHR: 1.25 (1.09–1.42); P < 0.001]. The corresponding 3-year aHRs for death were 0.83 (0.77–0.89) for overweight, 0.74 (0.67–0.82) for obesity class I (BMI 30–34.9 kg/m2), 0.78 (0.68–0.90) for obesity class II (BMI 35–39.9 kg/m2), and 0.75 (0.60–0.93) for obesity class III (BMI ≥ 40 kg/m2, P for all categories < 0.001). Individuals with class III obesity had a higher risk of readmission [sub-aHR: 1.17 (1.06–1.30)]. There were no differences in rates of device-related complications within 90 days across BMI categories. Conclusion: Most elderly patients with HF receiving CRT-D were overweight or obese. While being underweight was associated with greater risks of death and hospitalization, overweight and obese patients were at lower risk of death after CRT-D.
AB - Aims: To assess the association of body mass index (BMI) with heart failure (HF) outcomes after cardiac resynchronization therapy with defibrillator (CRT-D) implantation. Methods and results: Medicare beneficiaries with HF aged ≥ 65 years (n = 18 922) undergoing first-time CRT-D from the National Cardiovascular Data Registry (NCDR) Implantable Cardioverter-Defibrillator Registry between 2010 and 2013, were followed for 3 years post-implantation. Survival curves and covariate adjusted hazard ratio (aHR) or odds ratio were used to assess the risks for death, readmission, and device-related complications by BMI status. Of 18 922 HF patients receiving CRT-D, 5265 (27.8%) were normal weight, 6896 (37%) were overweight, 6318 (33.4%) were obese, and 353 (1.8%) were underweight. Compared to those of normal weight (BMI 18.5–24.9 kg/m2), underweight patients had a higher 3-year post-device implantation risk of death [aHR: 1.34 (95% confidence interval 1.09–1.65); P < 0.001] and of readmission [sub-aHR: 1.25 (1.09–1.42); P < 0.001]. The corresponding 3-year aHRs for death were 0.83 (0.77–0.89) for overweight, 0.74 (0.67–0.82) for obesity class I (BMI 30–34.9 kg/m2), 0.78 (0.68–0.90) for obesity class II (BMI 35–39.9 kg/m2), and 0.75 (0.60–0.93) for obesity class III (BMI ≥ 40 kg/m2, P for all categories < 0.001). Individuals with class III obesity had a higher risk of readmission [sub-aHR: 1.17 (1.06–1.30)]. There were no differences in rates of device-related complications within 90 days across BMI categories. Conclusion: Most elderly patients with HF receiving CRT-D were overweight or obese. While being underweight was associated with greater risks of death and hospitalization, overweight and obese patients were at lower risk of death after CRT-D.
KW - Body mass index
KW - Cardiac resynchronization therapy
KW - Heart failure
KW - Implantable cardioverter-defibrillator
KW - Outcomes
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U2 - 10.1002/ejhf.1552
DO - 10.1002/ejhf.1552
M3 - Article
C2 - 31359595
AN - SCOPUS:85070262849
SN - 1388-9842
VL - 21
SP - 1093
EP - 1102
JO - European Journal of Heart Failure
JF - European Journal of Heart Failure
IS - 9
ER -