Impact of longitudinal weight change on clinical outcomes in heart failure: evidence from a nationwide multi-ethnic asian cohort

Background

Weight change is an important marker of nutritional status, fluid retention, and overall disease trajectory in Heart Failure (HF). In addition, weight loss has been associated with adverse outcomes and obesity as beneficial (obesity paradox). However, its prognostic significance in the Asian HF populations remains uncertain.

Purpose

We evaluated the impact of significant weight change (≥10% variation over ≥6 months) on clinical outcomes in a real-world national asian HF cohort.

Methods

We included 2,534 Heart Failure patients from 8 tertiary hospitals in Singapore between 2016 and 2024, each with ≥2 recorded weight measurements at least 6 months apart. Weight change was defined using a ≥10% threshold and classified into: Weight Loss, Stable Weight, or Weight Gain. For each patient, the latest available BMI prior to the event (or the latest BMI for event-free individuals) was used to anchor weight-change classification. The primary endpoint was a composite of all-cause mortality or HF rehospitalization. Kaplan–Meier curves compared event-free survival, and multivariable Cox proportional hazards models adjusted for age, sex, and NYHA class.

Results

Among 2,534 HF patients, 427 (17%) experienced significant weight loss, 1,649 (65%) maintained stable weight, and 458 (18%) experienced significant weight gain. Kaplan–Meier analysis showed significantly different event-free survival across groups (log-rank p = 0.0199), with weight loss associated with the worst outcomes. In the adjusted Cox model:

●Weight Loss predicted higher risk of the composite outcome (HR 1.186, 95% CI 1.018–1.382, p = 0.029).

●Weight Gain was not associated with increased risk (HR 0.951, 95% CI 0.808–1.120, p = 0.547).

●NYHA class (HR 1.573, p < 0.001), male sex (HR 1.361, p < 0.001), and older age (HR 1.026 per year, p < 0.001) were significant predictors.

Conclusions

In this contemporary Asian HF cohort, ≥10% weight loss over at least 6 months was independently associated with adverse clinical outcomes, while weight gain was not harmful. Weight stability was associated with the most favorable prognosis. Using the latest pre-event BMI measurement ensures that weight trajectories reflect the patient’s true physiologic status at the time of risk. These findings support routine longitudinal weight monitoring as a simple, clinically meaningful tool for HF risk stratification and guide treatment and or management.Composite Outcome by Weight ChangeFor image description, please refer to the figure legend and surrounding text.Weight Change (by Age, Sex and NYHA)For image description, please refer to the figure legend and surrounding text.