Heart failure treatment in patients with and without obesity with an ejection fraction below 50%

Yaar S. Aga; Sumant P. Radhoe; Dilan Aydin; G. C.M. Linssen; Philip C. Rademaker; Peter R. Geerlings; Marco W.F. van Gent; Ismail Aksoy; Liane Oosterom; Hans Peter Brunner-La Rocca; Bas M. van Dalen; Jasper J. Brugts

doi:10.1111/eci.13976

Heart failure treatment in patients with and without obesity with an ejection fraction below 50%

Yaar S. Aga
, Sumant P. Radhoe
, Dilan Aydin
, G. C.M. Linssen
, Philip C. Rademaker
, Peter R. Geerlings
, Marco W.F. van Gent
, Ismail Aksoy
, Liane Oosterom
, Hans Peter Brunner-La Rocca
, Bas M. van Dalen
, Jasper J. Brugts^*

^*Corresponding author for this work

Cardiology

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Background: The aim of this study was to assess heart failure (HF) treatment in patients with and without obesity in a large contemporary real-world Western European cohort. Methods: Patients with a left ventricular ejection fraction (LVEF) <50% and available information on body mass index (BMI) were selected from the CHECK-HF registry. The CHECK-HF registry included chronic HF patients in the period between 2013 and 2016 in 34 Dutch outpatient clinics. Patients were divided into BMI categories. Differences in HF medical treatment were analysed, and multivariable logistic regression analysis (dichotomized as BMI <30 kg/m² and ≥30 kg/m²) was performed. Results: Seven thousand six hundred seventy-one patients were included, 1284 (16.7%) had a BMI ≥30 kg/m², and 618 (8.1%) had a BMI ≥35 kg/m². Median BMI was 26.4 kg/m². Patients with obesity were younger and had a higher rate of comorbidities such as diabetes mellitus, hypertension and obstructive sleep apnoea (OSAS). Prescription rates of guideline-directed medical therapy (GDMT) increased significantly with BMI. The differences were most pronounced for mineralocorticoid receptor antagonists (MRAs) and diuretics. Patients with obesity more often received the guideline-recommended target dose. In multivariable logistic regression, obesity was significantly associated with a higher likelihood of receiving ≥100% of the guideline-recommended target dose of beta-blockers (OR 1.34, 95% CI 1.10–1.62), renin–angiotensin system (RAS)-inhibitors (OR 1.34, 95% CI 1.15–1.57) and MRAs (OR 1.40, 95% CI 1.04–1.87). Conclusions: Guideline-recommended HF drugs are more frequently prescribed and at a higher dose in patients with obesity as compared to HF patients without obesity.

Original language	English
Article number	e13976
Journal	European Journal of Clinical Investigation
Volume	53
Issue number	7
DOIs	https://doi.org/10.1111/eci.13976
Publication status	Published - Jul 2023

Bibliographical note

Funding Information:
The steering committee (H.-P.B.-L.R., G.C.M.L. and J.J.B.) received no funding for this project. This analysis was initiated by the authors and was designed, conducted, interpreted and reported independently of the sponsor, Servier, who funded in part the database and software program.

Publisher Copyright:
© 2023 The Authors. European Journal of Clinical Investigation published by John Wiley & Sons Ltd on behalf of Stichting European Society for Clinical Investigation Journal Foundation.

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Aga, Y. S., Radhoe, S. P., Aydin, D., Linssen, G. C. M., Rademaker, P. C., Geerlings, P. R., van Gent, M. W. F., Aksoy, I., Oosterom, L., Brunner-La Rocca, H. P., van Dalen, B. M., & Brugts, J. J. (2023). Heart failure treatment in patients with and without obesity with an ejection fraction below 50%. European Journal of Clinical Investigation, 53(7), Article e13976. https://doi.org/10.1111/eci.13976

@article{4abb65c8d0f443cda5437f1d569f8347,

title = "Heart failure treatment in patients with and without obesity with an ejection fraction below 50\%",

abstract = "Background: The aim of this study was to assess heart failure (HF) treatment in patients with and without obesity in a large contemporary real-world Western European cohort. Methods: Patients with a left ventricular ejection fraction (LVEF) <50\% and available information on body mass index (BMI) were selected from the CHECK-HF registry. The CHECK-HF registry included chronic HF patients in the period between 2013 and 2016 in 34 Dutch outpatient clinics. Patients were divided into BMI categories. Differences in HF medical treatment were analysed, and multivariable logistic regression analysis (dichotomized as BMI <30 kg/m2 and ≥30 kg/m2) was performed. Results: Seven thousand six hundred seventy-one patients were included, 1284 (16.7\%) had a BMI ≥30 kg/m2, and 618 (8.1\%) had a BMI ≥35 kg/m2. Median BMI was 26.4 kg/m2. Patients with obesity were younger and had a higher rate of comorbidities such as diabetes mellitus, hypertension and obstructive sleep apnoea (OSAS). Prescription rates of guideline-directed medical therapy (GDMT) increased significantly with BMI. The differences were most pronounced for mineralocorticoid receptor antagonists (MRAs) and diuretics. Patients with obesity more often received the guideline-recommended target dose. In multivariable logistic regression, obesity was significantly associated with a higher likelihood of receiving ≥100\% of the guideline-recommended target dose of beta-blockers (OR 1.34, 95\% CI 1.10–1.62), renin–angiotensin system (RAS)-inhibitors (OR 1.34, 95\% CI 1.15–1.57) and MRAs (OR 1.40, 95\% CI 1.04–1.87). Conclusions: Guideline-recommended HF drugs are more frequently prescribed and at a higher dose in patients with obesity as compared to HF patients without obesity.",

author = "Aga, \{Yaar S.\} and Radhoe, \{Sumant P.\} and Dilan Aydin and Linssen, \{G. C.M.\} and Rademaker, \{Philip C.\} and Geerlings, \{Peter R.\} and van Gent, \{Marco W.F.\} and Ismail Aksoy and Liane Oosterom and Brunner-La Rocca, \{Hans Peter\} and van Dalen, \{Bas M.\} and Brugts, \{Jasper J.\}",

note = "Funding Information: The steering committee (H.-P.B.-L.R., G.C.M.L. and J.J.B.) received no funding for this project. This analysis was initiated by the authors and was designed, conducted, interpreted and reported independently of the sponsor, Servier, who funded in part the database and software program. Publisher Copyright: {\textcopyright} 2023 The Authors. European Journal of Clinical Investigation published by John Wiley \& Sons Ltd on behalf of Stichting European Society for Clinical Investigation Journal Foundation.",

year = "2023",

month = jul,

doi = "10.1111/eci.13976",

language = "English",

volume = "53",

journal = "European Journal of Clinical Investigation",

issn = "0014-2972",

publisher = "John Wiley \& Sons Inc.",

number = "7",

}

Aga, YS, Radhoe, SP, Aydin, D, Linssen, GCM, Rademaker, PC, Geerlings, PR, van Gent, MWF, Aksoy, I, Oosterom, L, Brunner-La Rocca, HP, van Dalen, BM & Brugts, JJ 2023, 'Heart failure treatment in patients with and without obesity with an ejection fraction below 50%', European Journal of Clinical Investigation, vol. 53, no. 7, e13976. https://doi.org/10.1111/eci.13976

TY - JOUR

T1 - Heart failure treatment in patients with and without obesity with an ejection fraction below 50%

AU - Aga, Yaar S.

AU - Radhoe, Sumant P.

AU - Aydin, Dilan

AU - Linssen, G. C.M.

AU - Rademaker, Philip C.

AU - Geerlings, Peter R.

AU - van Gent, Marco W.F.

AU - Aksoy, Ismail

AU - Oosterom, Liane

AU - Brunner-La Rocca, Hans Peter

AU - van Dalen, Bas M.

AU - Brugts, Jasper J.

N1 - Funding Information: The steering committee (H.-P.B.-L.R., G.C.M.L. and J.J.B.) received no funding for this project. This analysis was initiated by the authors and was designed, conducted, interpreted and reported independently of the sponsor, Servier, who funded in part the database and software program. Publisher Copyright: © 2023 The Authors. European Journal of Clinical Investigation published by John Wiley & Sons Ltd on behalf of Stichting European Society for Clinical Investigation Journal Foundation.

PY - 2023/7

Y1 - 2023/7

N2 - Background: The aim of this study was to assess heart failure (HF) treatment in patients with and without obesity in a large contemporary real-world Western European cohort. Methods: Patients with a left ventricular ejection fraction (LVEF) <50% and available information on body mass index (BMI) were selected from the CHECK-HF registry. The CHECK-HF registry included chronic HF patients in the period between 2013 and 2016 in 34 Dutch outpatient clinics. Patients were divided into BMI categories. Differences in HF medical treatment were analysed, and multivariable logistic regression analysis (dichotomized as BMI <30 kg/m2 and ≥30 kg/m2) was performed. Results: Seven thousand six hundred seventy-one patients were included, 1284 (16.7%) had a BMI ≥30 kg/m2, and 618 (8.1%) had a BMI ≥35 kg/m2. Median BMI was 26.4 kg/m2. Patients with obesity were younger and had a higher rate of comorbidities such as diabetes mellitus, hypertension and obstructive sleep apnoea (OSAS). Prescription rates of guideline-directed medical therapy (GDMT) increased significantly with BMI. The differences were most pronounced for mineralocorticoid receptor antagonists (MRAs) and diuretics. Patients with obesity more often received the guideline-recommended target dose. In multivariable logistic regression, obesity was significantly associated with a higher likelihood of receiving ≥100% of the guideline-recommended target dose of beta-blockers (OR 1.34, 95% CI 1.10–1.62), renin–angiotensin system (RAS)-inhibitors (OR 1.34, 95% CI 1.15–1.57) and MRAs (OR 1.40, 95% CI 1.04–1.87). Conclusions: Guideline-recommended HF drugs are more frequently prescribed and at a higher dose in patients with obesity as compared to HF patients without obesity.

AB - Background: The aim of this study was to assess heart failure (HF) treatment in patients with and without obesity in a large contemporary real-world Western European cohort. Methods: Patients with a left ventricular ejection fraction (LVEF) <50% and available information on body mass index (BMI) were selected from the CHECK-HF registry. The CHECK-HF registry included chronic HF patients in the period between 2013 and 2016 in 34 Dutch outpatient clinics. Patients were divided into BMI categories. Differences in HF medical treatment were analysed, and multivariable logistic regression analysis (dichotomized as BMI <30 kg/m2 and ≥30 kg/m2) was performed. Results: Seven thousand six hundred seventy-one patients were included, 1284 (16.7%) had a BMI ≥30 kg/m2, and 618 (8.1%) had a BMI ≥35 kg/m2. Median BMI was 26.4 kg/m2. Patients with obesity were younger and had a higher rate of comorbidities such as diabetes mellitus, hypertension and obstructive sleep apnoea (OSAS). Prescription rates of guideline-directed medical therapy (GDMT) increased significantly with BMI. The differences were most pronounced for mineralocorticoid receptor antagonists (MRAs) and diuretics. Patients with obesity more often received the guideline-recommended target dose. In multivariable logistic regression, obesity was significantly associated with a higher likelihood of receiving ≥100% of the guideline-recommended target dose of beta-blockers (OR 1.34, 95% CI 1.10–1.62), renin–angiotensin system (RAS)-inhibitors (OR 1.34, 95% CI 1.15–1.57) and MRAs (OR 1.40, 95% CI 1.04–1.87). Conclusions: Guideline-recommended HF drugs are more frequently prescribed and at a higher dose in patients with obesity as compared to HF patients without obesity.

UR - https://www.scopus.com/pages/publications/85150492133

U2 - 10.1111/eci.13976

DO - 10.1111/eci.13976

M3 - Article

C2 - 36841951

AN - SCOPUS:85150492133

SN - 0014-2972

VL - 53

JO - European Journal of Clinical Investigation

JF - European Journal of Clinical Investigation

IS - 7

M1 - e13976

ER -

Heart failure treatment in patients with and without obesity with an ejection fraction below 50%

Abstract

Bibliographical note

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