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Obesity linked with improved long-term survival after CRT-D implantation

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NATIONAL HARBOR, Md. — Patients with a BMI greater than 25 kg/m² had improved survival at 10 years after undergoing cardiac resynchronization therapy with a defibrillator, according to data presented at the Heart Failure Society of America Annual Scientific Meeting.

“Previous studies have demonstrated that obesity confers a paradoxical survival benefit among patients with HF,” Alison L. Wand, MD, an intern at the Johns Hopkins Hospital, and colleagues wrote in an abstract. “This obesity paradox has been described in HF patients undergoing [CRT] with a defibrillator, but these studies have been restricted to short-term follow-up.”

The new study included 113 patients who underwent CRT with a defibrillator (CRT-D) at the University of Pennsylvania from May 2002 to November 2003. Patients were divided into three groups based on pre-implantation BMI: normal weight (BMI < 25 kg/m²; 29.2%); overweight and obese (BMI 25 to 35 kg/m²; 58.4%) or morbidly obese (BMI > 35 kg/m²; 12.4%).

The primary endpoint was death, orthotopic heart transplant or need for ventricular assist device. Patients were followed for 10 years for the primary endpoint.

During the median follow-up period of 4.5 years (interquartile range, 1.9 to 8.7 years), 73 patients died, 12 required an orthotopic heart transplant and three required a VAD. While baseline characteristics between the BMI groups were similar, morbidly obese patients were more likely to be younger and have lower creatinine and higher hemoglobin.

“We found that obese patients undergoing CRT-D had improved survival over long-term follow-up compared to their lighter counterparts,” Wand said during a presentation.

The researchers observed a 7% decrease in risk for the primary endpoint for every 1-kg/m² increase in BMI. Increasing BMI category was associated with lower risk for the primary endpoint (HR = 0.59; 95% CI, 0.42-0.83), a correlation that remained after multivariate adjustment and adjustment for baseline left ventricular size, left atrium size and right ventricular function (HR = 0.38; 95% CI, 0.18-0.85; n = 55), according to the findings.

“Additional studies are needed to confirm these findings in larger cohorts and to explore the mechanisms driving the interaction between obesity and CRT,” the researchers concluded. – by Julia Ernst, MS

References:

Wand AL, et al. Rapid Fire Abstracts 1. Presented at: Heart Failure Society of American Annual Meeting; Sept. 26-29, 2015; National Harbor, Maryland.

Wand AL, et al. J Card Fail. 2015;doi:10.1016/j.cardfail.2015.06.071.

Disclosure: Wand reports no relevant financial disclosures.