Obesity and patient-reported health status in heart failure with preserved ejection fraction: a pooled analysis of 4 randomized clinical trials
J Ostrominski, Y Hamatani, B Claggett, J Butt, A Desai, P Jhund, C Lam, E Lewis, M Packer, M Pfeffer, B Pitt, F Zannad, J Mcmurray, S Solomon, M VaduganathanAbstract
Background
Obesity is associated with greater symptoms and functional limitations in persons with heart failure (HF), but whether obesity status preferentially impacts specific domains of health status in this population has not been rigorously evaluated.
Purpose
To ascertain the association between body mass index (BMI) and 1) individual components of the Kansas City Cardiomyopathy Questionnaire (KCCQ); and 2) change in KCCQ components over time.
Methods
This participant-level pooled analysis considered KCCQ-23 data from 4 global trials (TOPCAT-Americas, PARAGON-HF, DELIVER, and FINEARTS-HF) in HF with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF). First, the association between BMI category (≥30 vs. <30 kg/m2) and 1) each KCCQ-23 domain; and 2) individual KCCQ-23 components was examined at baseline. Second, changes in KCCQ-23 domains and components were evaluated between baseline and 12 months among participants randomized to control, by baseline BMI.
Results
Among 18,798 individuals (mean age, 72±7 years; 47% female; mean BMI, 30.4±6.2 kg/m2), 48% had a baseline BMI ≥30 kg/m2. At baseline, participants with BMI ≥30 kg/m2 had lower KCCQ-Overall Summary Scale (OSS) scores vs. those with BMI <30 kg/m2 (63 vs. 68; P for comparison<0.001). Compared with BMI <30 kg/m2, participants with BMI ≥30 kg/m2 exhibited greater impairments in all KCCQ-23 domains at baseline (Figure 1A), with greatest between-group differences in the symptom frequency (adjusted mean difference [AMD], -6.8; 95% CI, -7.5 to -6.1; P<0.001) and physical limitations domains (AMD, -6.0; 95% CI, -6.7 to -5.3; P<0.001). When individual KCCQ-23 components were examined, impairments in lower extremity swelling, walking, and climbing stairs were greatest among participants with BMI ≥30 kg/m2 vs. <30 kg/m2 (Figure 2A). Between baseline and 12 months, KCCQ-OSS scores improved in both BMI subgroups, but to a lesser extent among those with BMI ≥30 kg/m2 (+2.1 vs. +3.9; AMD, -1.8; 95% CI, -2.7 to -1.0; P<0.001). These findings were principally driven by lesser improvements in the social limitations, symptom frequency, physical limitations, symptom burden, and quality of life domains in participants with BMI ≥30 kg/m2 (Figures 1B and 2B).
Conclusion
In this analysis, higher BMI was associated with substantially greater impairments across a diverse range of health status domains, and with blunted improvements over time. These findings support the positioning of obesity treatment as important and person-centered component of comprehensive HFmrEF/HFpEF management efforts.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.