Pragmatic Weight Management Program for Patients With Obesity and Heart Failure With Preserved Ejection Fraction

Abstract

Background Obesity is associated with heart failure with preserved ejection fraction (HFpEF). Weight loss can improve exercise capacity in HFpEF. However, previously reported methods of weight loss are impractical for widespread clinical implementation. We tested the hypothesis that an intensive lifestyle modification program would lead to relevant weight loss and improvement in functional status in patients with HFpEF and obesity. Methods and Results Patients with ejection fraction >45%, at least 1 objective criteria for HFpEF, and body mass index ≥30 kg/m 2 were offered enrollment in an established 15‐week weight management program that included weekly visits for counseling, weight checks, and provision of meal replacements. At baseline, 15 weeks, and 26 weeks, Minnesota Living With Heart Failure score, 6‐minute walk distance, echocardiography, and laboratory variables were assessed. A total of 41 patients completed the study (mean body mass index, 40.8 kg/m 2 ), 74% of whom lost >5% of their baseline body weight following the 15‐week program. At 15 weeks, mean 6‐minute walk distance increased from 223 to 281 m ( P =0.001) and then decreased to 267 m at 26 weeks. Minnesota Living With Heart Failure score improved from 59.9 to 37.3 at 15 weeks ( P <0.001) and 37.06 at 26 weeks. Changes in weight correlated with change in Minnesota Living With Heart Failure score ( r =0.452; P =0.000) and 6‐minute walk distance ( r =−0.388; P <0.001). Conclusions In a diverse population of patients with obesity and HFpEF, clinically relevant weight loss can be achieved with a pragmatic 15‐week program. This is associated with significant improvements in quality of life and exercise capacity. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02911337.

Dapagliflozin for heart failure according to body mass index: the DELIVER trial

“…One example is caloric restriction and aerobic exercise training which was shown to lead to a larger decrease in weight, and improvement in peak oxygen consumption but no consistent improvement in health-related quality of life. 31 , 32 Glucagon-like peptide-1 receptor agonists and related treatments are currently under investigation as weight-loss treatments in HFpEF patients with obesity ( www.ClinicalTrials.gov , NCT04788511, NCT04847557, and NCT04916470).…”

Obesity, heart failure with preserved ejection fraction, and the role of glucagon‐like peptide‐1 receptor agonists

“…Kitzman et al showed that among obese older patients with clinically stable HFpEF, caloric restriction and/or aerobic exercise training increased peak oxygen consumption, and their effects were additive 101 . Similarly, dietary treatment/prevention programmes among obese HFpEF patients showed that a loss of ≈7% body weight was associated with a 37% decrease in Minnesota Living With Heart Failure (MLWHF) score and a 29% increase in 6 min walking distance (6MWD) test at completion of the 15 week programme, compared with baseline 105 …”

“…101 Similarly, dietary treatment/prevention programmes among obese HFpEF patients showed that a loss of ≈7% body weight was associated with a 37% decrease in Minnesota Living With Heart Failure (MLWHF) score and a 29% increase in 6 min walking distance (6MWD) test at completion of the 15 week programme, compared with baseline. 105 Also, bariatric surgery in obese patients with HFpEF has been shown to improve symptoms and New York Heart Association (NYHA) class, as well as reduce HF readmissions and reverse LV remodelling, and improve LV distensibility. [106][107][108] In a nationwide analysis, mortality was lower among obese HFpEF patients with bariatric surgery compared with obese HFpEF patients without bariatric surgery.…”

Effects of treatment of non-alcoholic fatty liver disease on heart failure with preserved ejection fraction

“…Inflammatory markers, such as TNFα and CRP, were also significantly decreased by aerobic interval training and a low-calorie diet in a one-year randomized controlled trial ( 106 ). In addition, weight loss by exercise and caloric restriction is associated with improvements in cardiorespiratory fitness and exercise capacity among patients with HFpEF ( 107 , 108 ). These may improve the physical condition of patients with HFpEF and their quality of life.…”