Abstract 18426: Impact of Body Mass Index on Heart Failure With Preserved or Reduced Ejection Fraction: Outcomes According to Race and Ethnicity From Get With The Guidelines-Heart Failure (GWTG-HF) Registry

Abstract

Introduction: Research supports a J-shaped association between body mass index (BMI) and mortality in patients with coronary artery disease (CAD) regardless of race/ethnicity. However, whether a similar pattern is noted among heart failure (HF) patients is unclear, particularly since black patients are at highest risk for both obesity and heart failure. Methods: Patients ≥65 years old from the GWTG-HF registry linked to Medicare claims data from 2005-2011, were stratified by preserved (HFpEF) and reduced (HFrEF) ejection fraction HF and categorized by 5 racial/ethnic populations (white, black, Hispanic, Asian, and other). Adjusted-Cox regression assessed the association between BMI and 30-day mortality from live discharge. Restricted cubic splines illustrate the relationship. We used interaction terms to test whether the relationship between BMI and outcomes differed by race/ethnicity. Results: A total 39647 HF patients were included [white=32434 (81.8%); black=3809 (9.6%); Hispanic=1928 (4.9%); Asian=544 (1.4%);other=932 (2.3%)]. Blacks and Hispanics with HF were more likely class I obese or higher (BMI≥30) than whites or Asians (P < 0.0001). Among HFpEF, higher BMI was associated with lower 30 day mortality, up to 30 kg/m 2 with little change in risk above 30 (Figure; BMI=30 vs BMI=15 hazard ratio (HR) 0.48, 95% confidence interval (CI) 0.38 - 0.61). A smaller relationship was observed in HFrEF (BMI=30 vs BMI=15 HR 0.64, 95%CI 0.47 - 0.87). There were no significant BMI by race interactions related to mortality (P all >0.05). Conclusions: Although black and Hispanic HF patients were more likely to be obese than whites or Asians, higher BMI was associated with lower 30 day mortality in each racial/ethnic group in a manner not consistent with a J-shaped relationship as noted for CAD. Additionally, the differential slope of the association of obesity and mortality among HFpEF and HFrEF patients suggests differing mechanistic factors requiring further exploration.