Profile of Obesity and Comorbidities in Elderly Patients with Heart Failure

Alexandra Dădârlat-Pop, Adela Sitar-Tăut, Dumitru Zdrenghea, Bogdan Caloian, Raluca Tomoaia, Dana Pop, Anca Buzoianu, Alexandra Dădârlat-Pop, Adela Sitar-Tăut, Dumitru Zdrenghea, Bogdan Caloian, Raluca Tomoaia, Dana Pop, Anca Buzoianu

Abstract

Background and purpose: In Romania, robust data about the prevalence of obesity and heart failure are lacking, especially in the elderly; therefore, this study aims to analyze the profile of overweight and obese patients aged >65 years admitted to a Romanian hospital for worsening heart failure, and also their risk in the presence of comorbidities.

Patients and methods: This cross-sectional study was conducted in 126 consecutive elderly patients with overweight and obesity admitted to a Romanian hospital for worsening heart failure. They were divided into three groups: with reduced (<40%) - HFrEF, mid-range (40-49%) - HFmrEF and preserved (≥50%) ejection fraction - HFpEF. Obesity was defined according to the body mass index (BMI) status: obesity, ≥30 kg/m2; overweight, 25-29.9 kg/m2. The Charlson Comorbidity Index (CCI) was calculated to evaluate the severity of comorbidity, with a score ranging from 2 (only heart failure present and age >65 years) to 30 (extensive comorbidity).

Results: NT-proBNP values are negatively correlated with BMI only in patients with HFpEF. Creatinine clearance (p=0.0166), the presence of atrial fibrillation (p=0.0095) and NYHA functional class were independent predictors of increased NT-proBNP values. CCI score is negatively correlated with NT-proBNP values in patients with HFmrEF (r= -0.448, p=0.009) and HFpEF (r= -0.273, p=0.043). The CCI risk was not significantly different between the three groups.

Conclusion: Elderly heart failure patients with overweight or obesity have particular characteristics in terms of NT-proBNP values and presence of comorbidities. In the studied population, NT-proBNP levels were strongly influenced by renal function, NYHA functional class, the presence of atrial fibrillation and left ventricular ejection fraction.

Keywords: comorbidity; elderly patients; heart failure; obesity.

Conflict of interest statement

The authors report no conflicts of interest in this work.

© 2020 Dădârlat-Pop et al.

Figures

Figure 1
Figure 1
The relationship between NT-proBNP and creatinine clearance (Cockroft–Gault formula). NT-proBNP levels negatively correlated with the creatinine clearance estimated by Cockcroft–Gault equation in the group of patients with HFmrEF: r=−0.448, p=0.009 and HFpEF: r= −0.273, p=0.043, but not in the HFrEF group.
Figure 2
Figure 2
NT-proBNP values in patients with obesity and heart failure depending on the left ventricular ejection fraction and the presence of diabetes mellitus. NT-proBNP levels were influenced by the presence of diabetes mellitus. Patients with diabetes mellitus and heart failure had significantly different levels of natriuretic peptides (NT-proBNP), depending on left ventricular ejection fraction. NT-proBNP values were not significantly different between the three groups of patients with heart failure without diabetes mellitus.
Figure 3
Figure 3
The relationship between NT-proBNP and ejection fraction in heart failure patients with obesity and atrial fibrillation vs their counterparts without atrial fibrillation. Patients with heart failure and atrial fibrillation presented different levels of NT-proBNP levels, depending on left ventricular ejection fraction. Patients with HFrEF and atrial fibrillation presented higher natriuretic peptide levels in comparison with those with HFmrEF and HFpEF. In the absence of atrial fibrillation these differences were attenuated. The presence of atrial fibrillation (p=0.0095) was an independent predictor of increased NT-proBNP values.

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Source: PubMed

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