Clin Res Cardiol 100, Suppl 1, April 2011

P397 - The impact of gradual weight change on 5-year mortality in patients with systolic heart failure
J. S. Wolter1, J. Franke1, A. Hack1, L. Frankenstein1, A.-M. Schneeweiß1, P. Ehlermann1, M. Nelles1, H. A. Katus1, C. Zugck1
1Innere Med. III, Kardiologie, Angiologie u. Pneumologie, Universitätsklinikum Heidelberg, Heidelberg;
Aim: To examine weight trajectories according to body mass index (BMI) in ambulatory patients suffering from chronic systolic heart failure (CHF) and their possible impact on long-term mortality.
Methods: We included 475 clinically stable CHF-patients on individually optimized medical therapy (mean age 57.2 ± 11.9 years, 78.5% male). Next to other clinical and functional parameters, BMI was assessed at baseline (T1) and at subsequent ambulatory visits after 27± 9 months (T2), thus guaranteeing stable weight trajectories. Obesity was defined as BMI = 27 kg/m². Patients presenting with cachexia (weight loss >6% in 6 months) were excluded from the analysis. 5-year survival was stratified according to group of weight trajectory over time (weight change of: =-6% vs. >-6% to =-2% vs. >-2% to =2% vs. >2% to =6% vs. >6%). Secondly, in addition to group of weight trajectory, obesity status at T2 was taken into account for stratification of outcome.
Results: During follow-up (mean 37 months; 1472 patientyears) 78 patients (16.3%) died. Except for age and NTproBNP, no further confounding differences were found between the different groups of weight trajectories (highest age in the group with change of BMI between ‘>-6% to =-2%’, highest NTproBNP in group of weight loss ‘>6%’). Five-year survival rates were lowest among patients who lost more than 6% of their baseline weight (5-year mortality 40%) and highest among those in whom BMI either increased between “>2% to =6%”or remained stable (5-year mortality 10.7%) over time (log rank test p<0.0001; figure 1). After additional stratification according to obesity status at T2, the results were similar for patients with a BMI <27 kg/m². In the group of obese patients there was a trend to higher mortality in patients with weight reduction, however this did not reach statistical significance (log rank test p=0.064).
Conclusion: Next to renowned risk factors such as NTproBNP, the interpretation of weight trajectories according to BMI yields additional information for risk stratification in ambulatory patients suffering from CHF. Gradual weight loss over time correlates with poorer long-term prognosis in the overall cohort of CHF patients, particularly in patients who initially present with normal weight.


Clin Res Cardiol 100, Suppl 1, April 2011
Zitierung mit Vortrags- oder Posternummer s.o.
DOI 10.1007/s00392-011-1100-y