Yuichi J Shimada1, Yusuke Tsugawa2, David F M Brown3, Kohei Hasegawa3. 1. Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: yshimada@partners.org. 2. Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. 3. Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Abstract
BACKGROUND: The United States is battling obesity and heart failure (HF) epidemics. Although studies have suggested relationships between obesity and HF morbidity, little is known regarding the effects of substantial weight reduction in obese patients with HF. OBJECTIVES: This study investigated whether bariatric surgery is associated with a decreased rate of HF exacerbation. METHODS: We performed a self-controlled case series study of obese patients with HF who underwent bariatric surgery, using the population-based emergency department (ED) and inpatient sample in California, Florida, and Nebraska. Primary outcome was ED visit or hospitalization for HF exacerbation from 2005 to 2011. We used conditional logistic regression to compare the outcome event rate during sequential 12-month periods, using pre-surgery months 13 to 24 as the reference period. RESULTS: We identified 524 patients with HF who underwent bariatric surgery. During the reference period, 16.2% of patients had an ED visit or hospitalization for HF exacerbation. The rate remained unchanged in the subsequent 12-month pre-surgery period (15.3%; p = 0.67). In the first 12-month period after bariatric surgery, we observed a nonsignificantly reduced rate (12.0%; p = 0.052). However, the rate was significantly lower in the subsequent 13 to 24 months after bariatric surgery (9.9%; adjusted odds ratio: 0.57; p = 0.003). By contrast, there was no significant reduction in the rate of HF exacerbation among obese patients who underwent nonbariatric surgery (i.e., cholecystectomy, hysterectomy). CONCLUSIONS: Our findings indicate that bariatric surgery is associated with a decline in the rate of HF exacerbation requiring ED evaluation or hospitalization among obese patients with HF.
BACKGROUND: The United States is battling obesity and heart failure (HF) epidemics. Although studies have suggested relationships between obesity and HF morbidity, little is known regarding the effects of substantial weight reduction in obesepatients with HF. OBJECTIVES: This study investigated whether bariatric surgery is associated with a decreased rate of HF exacerbation. METHODS: We performed a self-controlled case series study of obesepatients with HF who underwent bariatric surgery, using the population-based emergency department (ED) and inpatient sample in California, Florida, and Nebraska. Primary outcome was ED visit or hospitalization for HF exacerbation from 2005 to 2011. We used conditional logistic regression to compare the outcome event rate during sequential 12-month periods, using pre-surgery months 13 to 24 as the reference period. RESULTS: We identified 524 patients with HF who underwent bariatric surgery. During the reference period, 16.2% of patients had an ED visit or hospitalization for HF exacerbation. The rate remained unchanged in the subsequent 12-month pre-surgery period (15.3%; p = 0.67). In the first 12-month period after bariatric surgery, we observed a nonsignificantly reduced rate (12.0%; p = 0.052). However, the rate was significantly lower in the subsequent 13 to 24 months after bariatric surgery (9.9%; adjusted odds ratio: 0.57; p = 0.003). By contrast, there was no significant reduction in the rate of HF exacerbation among obesepatients who underwent nonbariatric surgery (i.e., cholecystectomy, hysterectomy). CONCLUSIONS: Our findings indicate that bariatric surgery is associated with a decline in the rate of HF exacerbation requiring ED evaluation or hospitalization among obesepatients with HF.
Authors: Michael L O'Byrne; Sunghee Kim; Christoph P Hornik; Babatunde A Yerokun; Roland A Matsouaka; Jeffrey P Jacobs; Marshall L Jacobs; Richard A Jonas Journal: Circulation Date: 2017-06-16 Impact factor: 29.690
Authors: Tammy L Kindel; Tom Foster; Paul Goldspink; Steven J Kindel; John Corbett; Michael Widlanksy; Jennifer Strande Journal: Obes Surg Date: 2017-09 Impact factor: 4.129
Authors: Eiran Z Gorodeski; Parag Goyal; Scott L Hummel; Ashok Krishnaswami; Sarah J Goodlin; Linda L Hart; Daniel E Forman; Nanette K Wenger; James N Kirkpatrick; Karen P Alexander Journal: J Am Coll Cardiol Date: 2018-05-01 Impact factor: 24.094