Abstract 14767: Obesity is Associated With Greater Intensity of Guideline Recommended Therapy in Patients With Heart Failure With Reduced Ejection Fraction in the CHAMP-HF Registry

Introduction: Despite the importance of guideline-directed medical therapy (GDMT) in heart failure with reduced ejection fraction (HFrEF), treatment disparities by sex, race and age have been described. We hypothesized obesity might also be associated with less aggressive GDMT, due to both the difficulty of assessing volume status in obese patients and the challenge of separating the symptoms of obesity from those of HFrEF. We recently developed an intuitive measure for quantifying GDMT, the Kansas City Medical Optimization (KCMO) score, which is the average of total daily to target dose percentages for eligible GDMT drug classes, reflecting the percent of optimal GDMT prescribed (range 0-100%).

Aim: To examine the association between BMI and KCMO score, accounting for other factors influencing GDMT use.

Methods: Using the CHAMP-HF registry, we applied the KCMO score as the dependent variable and BMI as the primary predictor in a hierarchical linear regression model with site-level random effects to account for clustering by site, and adjusting for age, sex, SBP, CKD, and KCCQ-12 scores. We also fit a separate model using WHO BMI classes in place of BMI. Non-linear associations were tested with restricted cubic splines.

Results: Among 4,163 patients across 150 sites in the CHAMP-HF registry, we found a significant and positive association between BMI and KCMO score (β _BMI = 0.40, SE = 0.06; p < 0.001). Compared to those with normal BMI, those with Class I-III obesity had higher KCMO scores by 3.95 ± 1.16, 6.11 ± 1.44, and 8.68 ± 1.53, respectively ( p < 0.001 for each).

Conclusions: Patients with HFrEF and higher BMIs received more intense GDMT. It remains to be seen whether this may contribute to the known “obesity paradox” in HFrEF, where higher BMI is associated with lower mortality. Further study is also needed to examine whether obese patients with HFrEF receive similar intensity and extent of treatment in regard to decongestive strategies.