Obesity and the risk of heart failure hospitalization and death in patients with heart failure and left ventricular ejection fraction >50% - results of 1 year follow-up of HF-POL study

Introduction

The incidence of heart failure with preserved ejection (HFpEF) has steadily increased and now accounts for over 50% of all HF cases. Obesity is widely recognized as a leading contributor to HFpEF, mainly due to chronic systemic and microvascular inflammation and subsequent left ventricle remodeling. However, the effect of obesity on disease progression and mortality remains unknown.

Purpose

Based on the HF-POL registry, the first Polish multicenter, prospective observational study of HF patients with EF over 40%, we aimed to describe the relation between obesity and HFpEF and determine the impact of obesity on 1-year prognosis.

Methods

Between October 2021 and June 2022 in 14 centers, 1497 consecutive patients were enrolled in the HF-POL registry, including 743 patients with HFpEF, of whom 327 patients (44%) were classified as obese (BMI>=30). We collected data of demographics, vital signs, medical history including HF etiology and hospitalization, concomitant medications, comorbidities, invasive cardiac procedures, and ECG, radiological, echocardiographic and laboratory results. The end points were defined as mortality or hospitalization due to heart failure (HHF) during 1-year observation.

Results

When comparing obese vs. non-obese HFpEF patients, significant differences in clinical profiles were observed (Table).

Obese patients were slightly younger than non-obese patients and tended to have a worse functional status, reflected by a higher New York Heart Association (NYHA) class. Correspondingly, obese patients had a higher number of comorbidities including diabetes, hypertension, chronic kidney disease, peripheral artery disease, atrial fibrillation, and peripheral edema. Despite comparable hemodynamic profiles, obese patients showed significantly lower levels of NT-pro-BNP. Regarding cardiac structure, ECG and echocardiographic parameters were comparable between groups, except for a significantly higher left ventricular mass index (LVMI) in obese patients. Additionally, obese patients more frequently presented with non-ischemic HF etiologies, pointing towards a metabolic- and comorbidity-driven HFpEF phenotype, and were treated more aggressively with angiotensin receptor blockers (ARBs), calcium-channel-blockers (CCBs), sodium-glucose cotransporter 2 inhibitors (SGLT2i) for diabetes and HF, and diuretics.

During the 1-year follow-up period, obese patients experienced more HHF (30.29% vs. 22.38%, 5.04). However, in the obese population the mortality rate was lower compared to non-obese patients (12.13% vs. 17.86%, p=0.037, Chi^2-Pearson: 4.33).

Conclusion

The data analysis of the HF-POL demonstrated significant differences related to obesity-phenotype in HFpEF patients in baseline characteristics and 1 year prognosis. These findings call for further investigation in phenotype-specific risk stratification of HFpEF patients to improve patient care.TableFor image description, please refer to the figure legend and surrounding text.