Haase, Christiane L.

Introduction: In people with heart failure (HF) with preserved ejection fraction (HFpEF), the associations between BMI, comorbidities and outcomes are not well-defined. This retrospective cohort study examined the association between BMI and hospitalizations in patients with HFpEF. Hypothesis: Higher BMI is associated with more HF-related hospitalizations and shorter time to HF-related hospitalization. Methods: Data for patients with BMI ≥25 kg/m 2 at the time of HFpEF diagnosis were extracted from LCED, a US claims-electronic medical record data set. Patients were categorized into 5 BMI groups: overweight and obesity classes I-IV (Figure A). Negative binomial and Cox proportional hazard models were used to estimate associations between BMI and number of HF-related hospitalizations and risk of HF-related hospitalization during follow-up. Analyses were adjusted for relevant baseline comorbidities, with age, sex and diabetes status as effect modifiers. Results: Among 4,975 patients, median age was 74 years and 57.5% were female. Compared with the overweight group, higher BMI groups had a lower median age (years: overweight 80; obesity III 68; obesity IV 64), fewer patients with cardiovascular (CV) history (overweight 81.0%; obesity III 77.0%; obesity IV 66.0%) and a greater proportion of female patients (overweight 56.4%; obesity III 57.9%; obesity IV 69.0%) (Figure A). Mean HF-related hospitalizations/100 patient-years was higher for obesity III (12) and IV (16) vs overweight (10) (effect of BMI: p=0.002; Figure B). The hazard ratio [95% CI] for HF-related hospitalization was 1.36 [0.97; 1.91] and 1.86 [1.32; 2.64] for obesity III and IV, relative to overweight (effect of BMI: p=0.010). Conclusions: Results suggest even though patients with HFpEF in higher BMI groups are younger and have less CV history at baseline, higher BMI is associated with greater burden of HF-related hospitalizations during follow-up, irrespective of age, sex and diabetes status.