Body mass and survival in patients with chronic heart failure without cachexia: The importance of obesity

• Published in: Journal of cardiac failure Vol. 9; no. 1; pp. 29 - 35
• Main Authors: Davos, Constantinos H., Doehner, Wolfram, Rauchhaus, Mathias, Cicoira, Mariantonietta, Francis, Darrel P., Coats, Andrew J.S., Clark, Andrew L., Anker, Stefan D.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-02-2003
• Subjects: Adrenergic beta-Agonists - therapeutic use; Age Factors; Aged; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Blood Pressure - physiology; Body Mass Index; Body Weight - physiology; cachexia; Cachexia - drug therapy; Cachexia - mortality; Cachexia - physiopathology; Chronic Disease; Chronic heart failure; Exercise Tolerance - physiology; Female; Follow-Up Studies; Heart Failure - drug therapy; Heart Failure - mortality; Heart Failure - physiopathology; Humans; London - epidemiology; Male; Middle Aged; Obesity - drug therapy; Obesity - mortality; Obesity - physiopathology; Oxygen Consumption - physiology; Predictive Value of Tests; Risk Factors; Severity of Illness Index; Statistics as Topic; Stroke Volume - physiology; survival; Survival Analysis; Time Factors; Treatment Outcome; London; Chronic heart failure; body mass index; cachexia; survival
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1054/jcaf.2003.4

Background: Cachexia in chronic heart failure carries a poor prognosis, but little is known about the influence of body mass on the prognosis of noncachectic heart failure patients. Methods: We studied 589 consecutive chronic heart failure patients followed for at least a year, in whom there were accurate baseline data for body mass. Results: Average age was 64.5 ± 12.4 years, left ventricular ejection fraction (LVEF) 30.9 ± 0.73%. Cachexia was present in 64. Noncachectic patients were divided into quintiles of body mass index (BMI), Q1 (BMI 22.2 ± 1.5) to Q5 (BMI 34.1 ± 2.8). There was no difference among the 5 groups in age, exercise capacity or LVEF. Survival was greatest in Q4 (1-year survival [95% confidence interval (CI)]) 0.91 (0.85–0.96) and 3-year survival 0.81 (0.73–0.89). Relative risks compared with Q4 were Q1: 2.3 (1.4–3.8); Q2: 1.7 (1.1–2.9); Q3: 1.8 (1.1–3.0); and Q5: 1.5 (0.9–2.5). In multivariate analysis of 1 year follow-up, peak oxygen consumption (hazard ratio with 95% CI) (0.89 [0.82–0.97]; P =.006), LVEF (0.94 [0.91–0.97]; P =.0002) and BMI (0.90 [0.82–0.98]; P =.02) independently predicted 1-year survival with a combined X2 value of 42.4. Age (1.01 [0.98–1.05] and diagnosis (1.56 [0.78–3.11]) was not a predictor of survival. Conclusion: In patients with chronic heart failure, increasing BMI is not an adverse prognostic feature. Thinner patients appear to have a poorer prognosis.