Body mass index and survival in people with heart failure

Nicholas R Jones; José M Ordóñez-Mena; Andrea K Roalfe; Kathryn S Taylor; Clare R Goyder; Fd Richard Hobbs; Clare J Taylor

doi:10.1136/heartjnl-2023-322459

Body mass index and survival in people with heart failure

Nicholas R Jones^*, José M Ordóñez-Mena, Andrea K Roalfe, Kathryn S Taylor, Clare R Goyder, Fd Richard Hobbs, Clare J Taylor

^*Corresponding author for this work

Applied Health Research

Research output: Contribution to journal › Article › peer-review

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Abstract

AIMS: In people with heart failure (HF), a high body mass index (BMI) has been linked with better outcomes ('obesity paradox'), but there is limited evidence in community populations across long-term follow-up. We aimed to examine the association between BMI and long-term survival in patients with HF in a large primary care cohort.

METHODS: We included patients with incident HF aged ≥45 years from the Clinical Practice Research Datalink (2000-2017). We used Kaplan-Meier curves, Cox regression and penalised spline methods to assess the association of pre-diagnostic BMI, based on WHO classification, with all-cause mortality.

RESULTS: There were 47 531 participants with HF (median age 78.0 years (IQR 70-84), 45.8% female, 79.0% white ethnicity, median BMI 27.1 (IQR 23.9-31.0)) and 25 013 (52.6%) died during follow-up. Compared with healthy weight, people with overweight (HR 0.78, 95% CI 0.75 to 0.81, risk difference (RD) -4.1%), obesity class I (HR 0.76, 95% CI 0.73 to 0.80, RD -4.5%) and class II (HR 0.76, 95% CI 0.71 to 0.81, RD -4.5%) were at decreased risk of death, whereas people with underweight were at increased risk (HR 1.59, 95% CI 1.45 to 1.75, RD 11.2%). In those underweight, this risk was greater among men than women (p value for interaction=0.02). Class III obesity was associated with increased risk of all-cause mortality compared with overweight (HR 1.23, 95% CI 1.17 to 1.29).

CONCLUSION: The U-shaped relationship between BMI and long-term all-cause mortality suggests a personalised approach to identifying optimal weight may be needed for patients with HF in primary care. Underweight people have the poorest prognosis and should be recognised as high-risk.

Original language	English
Pages (from-to)	1542-1549
Number of pages	8
Journal	Heart
Volume	109
Issue number	20
Early online date	8 Jun 2023
DOIs	https://doi.org/10.1136/heartjnl-2023-322459
Publication status	Published - 28 Sept 2023

Bibliographical note

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.

Acknowledgments
The SurviveHF protocol was approved by the Independent Scientific Advisory Committee to the Medicine and Healthcare products Regulatory Agency (protocol number 18_061R). This work uses data provided by patients and collected by the NHS as part of their care and support and would not have been possible without access to these data. The National Institute for Health Research recognises and values the role of patient data, securely accessed and stored, in underpinning and leading to improvements in research and care. HES and ONS data are subject to copyright (2018) and can be re-used with the permission of The Health and Social Care Information Centre. All rights reserved.

Keywords

Male
Humans
Female
Aged
Overweight/complications
Body Mass Index
Thinness/complications
Heart Failure
Obesity/complications
Risk Factors

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Cite this

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title = "Body mass index and survival in people with heart failure",

abstract = "AIMS: In people with heart failure (HF), a high body mass index (BMI) has been linked with better outcomes ('obesity paradox'), but there is limited evidence in community populations across long-term follow-up. We aimed to examine the association between BMI and long-term survival in patients with HF in a large primary care cohort.METHODS: We included patients with incident HF aged ≥45 years from the Clinical Practice Research Datalink (2000-2017). We used Kaplan-Meier curves, Cox regression and penalised spline methods to assess the association of pre-diagnostic BMI, based on WHO classification, with all-cause mortality.RESULTS: There were 47 531 participants with HF (median age 78.0 years (IQR 70-84), 45.8% female, 79.0% white ethnicity, median BMI 27.1 (IQR 23.9-31.0)) and 25 013 (52.6%) died during follow-up. Compared with healthy weight, people with overweight (HR 0.78, 95% CI 0.75 to 0.81, risk difference (RD) -4.1%), obesity class I (HR 0.76, 95% CI 0.73 to 0.80, RD -4.5%) and class II (HR 0.76, 95% CI 0.71 to 0.81, RD -4.5%) were at decreased risk of death, whereas people with underweight were at increased risk (HR 1.59, 95% CI 1.45 to 1.75, RD 11.2%). In those underweight, this risk was greater among men than women (p value for interaction=0.02). Class III obesity was associated with increased risk of all-cause mortality compared with overweight (HR 1.23, 95% CI 1.17 to 1.29).CONCLUSION: The U-shaped relationship between BMI and long-term all-cause mortality suggests a personalised approach to identifying optimal weight may be needed for patients with HF in primary care. Underweight people have the poorest prognosis and should be recognised as high-risk.",

keywords = "Male, Humans, Female, Aged, Overweight/complications, Body Mass Index, Thinness/complications, Heart Failure, Obesity/complications, Risk Factors",

author = "Jones, {Nicholas R} and Ord{\'o}{\~n}ez-Mena, {Jos{\'e} M} and Roalfe, {Andrea K} and Taylor, {Kathryn S} and Goyder, {Clare R} and Hobbs, {Fd Richard} and Taylor, {Clare J}",

note = "{\textcopyright} Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ. Acknowledgments The SurviveHF protocol was approved by the Independent Scientific Advisory Committee to the Medicine and Healthcare products Regulatory Agency (protocol number 18_061R). This work uses data provided by patients and collected by the NHS as part of their care and support and would not have been possible without access to these data. The National Institute for Health Research recognises and values the role of patient data, securely accessed and stored, in underpinning and leading to improvements in research and care. HES and ONS data are subject to copyright (2018) and can be re-used with the permission of The Health and Social Care Information Centre. All rights reserved.",

year = "2023",

month = sep,

day = "28",

doi = "10.1136/heartjnl-2023-322459",

language = "English",

volume = "109",

pages = "1542--1549",

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number = "20",

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TY - JOUR

T1 - Body mass index and survival in people with heart failure

AU - Jones, Nicholas R

AU - Ordóñez-Mena, José M

AU - Roalfe, Andrea K

AU - Taylor, Kathryn S

AU - Goyder, Clare R

AU - Hobbs, Fd Richard

AU - Taylor, Clare J

N1 - © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ. Acknowledgments The SurviveHF protocol was approved by the Independent Scientific Advisory Committee to the Medicine and Healthcare products Regulatory Agency (protocol number 18_061R). This work uses data provided by patients and collected by the NHS as part of their care and support and would not have been possible without access to these data. The National Institute for Health Research recognises and values the role of patient data, securely accessed and stored, in underpinning and leading to improvements in research and care. HES and ONS data are subject to copyright (2018) and can be re-used with the permission of The Health and Social Care Information Centre. All rights reserved.

PY - 2023/9/28

Y1 - 2023/9/28

N2 - AIMS: In people with heart failure (HF), a high body mass index (BMI) has been linked with better outcomes ('obesity paradox'), but there is limited evidence in community populations across long-term follow-up. We aimed to examine the association between BMI and long-term survival in patients with HF in a large primary care cohort.METHODS: We included patients with incident HF aged ≥45 years from the Clinical Practice Research Datalink (2000-2017). We used Kaplan-Meier curves, Cox regression and penalised spline methods to assess the association of pre-diagnostic BMI, based on WHO classification, with all-cause mortality.RESULTS: There were 47 531 participants with HF (median age 78.0 years (IQR 70-84), 45.8% female, 79.0% white ethnicity, median BMI 27.1 (IQR 23.9-31.0)) and 25 013 (52.6%) died during follow-up. Compared with healthy weight, people with overweight (HR 0.78, 95% CI 0.75 to 0.81, risk difference (RD) -4.1%), obesity class I (HR 0.76, 95% CI 0.73 to 0.80, RD -4.5%) and class II (HR 0.76, 95% CI 0.71 to 0.81, RD -4.5%) were at decreased risk of death, whereas people with underweight were at increased risk (HR 1.59, 95% CI 1.45 to 1.75, RD 11.2%). In those underweight, this risk was greater among men than women (p value for interaction=0.02). Class III obesity was associated with increased risk of all-cause mortality compared with overweight (HR 1.23, 95% CI 1.17 to 1.29).CONCLUSION: The U-shaped relationship between BMI and long-term all-cause mortality suggests a personalised approach to identifying optimal weight may be needed for patients with HF in primary care. Underweight people have the poorest prognosis and should be recognised as high-risk.

AB - AIMS: In people with heart failure (HF), a high body mass index (BMI) has been linked with better outcomes ('obesity paradox'), but there is limited evidence in community populations across long-term follow-up. We aimed to examine the association between BMI and long-term survival in patients with HF in a large primary care cohort.METHODS: We included patients with incident HF aged ≥45 years from the Clinical Practice Research Datalink (2000-2017). We used Kaplan-Meier curves, Cox regression and penalised spline methods to assess the association of pre-diagnostic BMI, based on WHO classification, with all-cause mortality.RESULTS: There were 47 531 participants with HF (median age 78.0 years (IQR 70-84), 45.8% female, 79.0% white ethnicity, median BMI 27.1 (IQR 23.9-31.0)) and 25 013 (52.6%) died during follow-up. Compared with healthy weight, people with overweight (HR 0.78, 95% CI 0.75 to 0.81, risk difference (RD) -4.1%), obesity class I (HR 0.76, 95% CI 0.73 to 0.80, RD -4.5%) and class II (HR 0.76, 95% CI 0.71 to 0.81, RD -4.5%) were at decreased risk of death, whereas people with underweight were at increased risk (HR 1.59, 95% CI 1.45 to 1.75, RD 11.2%). In those underweight, this risk was greater among men than women (p value for interaction=0.02). Class III obesity was associated with increased risk of all-cause mortality compared with overweight (HR 1.23, 95% CI 1.17 to 1.29).CONCLUSION: The U-shaped relationship between BMI and long-term all-cause mortality suggests a personalised approach to identifying optimal weight may be needed for patients with HF in primary care. Underweight people have the poorest prognosis and should be recognised as high-risk.

KW - Male

KW - Humans

KW - Female

KW - Aged

KW - Overweight/complications

KW - Body Mass Index

KW - Thinness/complications

KW - Heart Failure

KW - Obesity/complications

KW - Risk Factors

U2 - 10.1136/heartjnl-2023-322459

DO - 10.1136/heartjnl-2023-322459

M3 - Article

C2 - 37290898

SN - 1355-6037

VL - 109

SP - 1542

EP - 1549

JO - Heart

JF - Heart

IS - 20

ER -

Body mass index and survival in people with heart failure

Abstract

Bibliographical note

Keywords

UN SDGs

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