Obesity/overweight in the full spectrum of contemporary heart failure: clinical profile. presentation. and management in the AMERICCAASS Registry

Introduction and objectives

Nutritional status. as determined by the body mass index (BMI). plays a significant role in the management of heart failure (HF). especially in the context of obesity and overweight. The objectives of this study were first. to identify the clinical characteristics and therapeutic strategies based on nutritional status; and second. to determine the prevalence of obesity and overweight in various clinical scenarios among patients with HF across the full spectrum of presentation in the Americas.

Material and methods

The AMERICCAASS Registry was a prospective. multicenter. observational registry involving 119 institutions in 21 countries of the Americas. Patients with a confirmed diagnosis of HF. classified as inpatient or outpatient. were included. Sociodemographic and clinical data were extracted from medical records and descriptively analyzed to characterize the study population. For the present analysis. individuals with height and weight available for BMI (kg/m2) determination were selected. and they were classified as Underweight (<18.5). Normal (18.5–24.9). Overweight (25.0–29.9). and Obesity (≥30.0). Based on LVEF, population was classified as HFrEF≤40%, HFmrEF 41-49% and HFpEF ≥50%.

Results

A total of 5896 individuals were included. 4187 outpatients and 1709 hospitalized. The distribution according to BMI in the global population was Underweight (n=117. 2%). Normal (n=2039. 34.6%). Overweight (n=2285. 38.8%). and Obesity (n=1455; 24%)). BMI categories were not different between outpatients and inpatients (χ²=1.79; p=0.62). but significant differences were observed between HfrEF. HfmrEF and HFpEF (χ²=16.3; gl=6; p=0.012).(Tabla 1). The prevalence of obesity/overweight was similar between outpatients and hospitalized patients (63.4% vs 63.6%; χ²=0.005; p=0.946; RR=1.00. 95% CI 0.96–1.05). In contrast. obesity/overweight significantly increase from HFrEF. HFmrEF and HFpEF (62.3. 65.9. 67%. respectively; χ²=10.40; p=0.0055). Compared with HFrEF. the hazard ratio for obesity/overweight prevalence was 1.17 (95%CI=1.00–1.38) in HFmrEF and 1.2 (95%CI=1.07–1.41) in HFpEF.

The comparison of risk factors, clinical profile and treatment among BMI categories is displayed in Table 1. Groups with obesity and overweight showed higher prevalence of cardiometabolic factors, atrial fibrillation, with lower levels of natriuretic peptides. Except for betablocker, the use of drugs was different among categories.

Conclusions

Approximately two thirds of patients with heart failure across American countries are either obese or overweight. No significant association was found between BMI and the clinical scenario of presentation. However, the prevalence of obesity/overweight was higher in individuals with the HFpEF phenotype. Furthermore, the clinical profile of patients differed according to BMI categories, which may have influenced the choice and application of drugs.Table 1