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/m2 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/m2), 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.

Keywords: exercise; heart failure with preserved ejection fraction; left ventricular hypertrophy; obesity; quality of life; weight loss.

Figures

Figure 1. Study design.

Sixty‐five patients were initially enrolled in the study. Twenty‐four dropped out, and 41 successfully completed the 15‐week weight loss program. A total of 37 of the 41 study participants returned at 26 weeks for data collection. *The interval for quality‐of‐life questionnaires (Minnesota Living With Heart Failure, New York Heart Association, and Borg dyspnea and fatigue scores, as well as laboratory, echocardiographic, and 6‐minute walk testing).

Figure 2. Weight loss at 15 weeks was associated with significantly improved 6‐minute walk test (6MWT) and Minnesota Living With Heart Failure (MLWHF) score, indicative of improved quality of life.

The beneficial effects of the weight loss intervention on 6MWT and MLWHF score persisted until 26 weeks. Statistical significance is denoted. *P<0.05, baseline vs 15 weeks; †P<0.05, baseline vs 26 weeks.

Figure 3. Weight loss significantly improved New York Heart Association (NYHA) functional score, as well as the Borg dyspnea (BORGD) and Borg fatigue (BORGF) scores at both 15 and 26 weeks.

Statistical significance is denoted. *P<0.05, baseline vs 15 weeks; †P<0.05, baseline vs 26 weeks.