Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA.
J Am Heart Assoc. 2018 Mar 15;7(6):e008243. doi: 10.1161/JAHA.117.008243.
Obesity and heart failure (HF) are important public health problems in the United States. Although studies have reported the association between obesity and higher chronic morbidity of HF, little is known about the relations of obesity with severity of HF exacerbation and in-hospital mortality; therefore, we aimed to investigate the associations of obesity with severity of HF exacerbation and in-hospital mortality.
This retrospective cohort study of adults hospitalized for HF exacerbation used population-based data sets (the State Inpatient Databases) of 7 US states from 2012 to 2013. The outcomes were acute severity measures-use of positive pressure ventilation and hospital length of stay-and in-hospital mortality. We determined the associations between obesity and these outcomes, including adjustment for sociodemographic factors and comorbidities. We identified 219 465 patients hospitalized for HF exacerbation. Of those, 37 539 (17.1%) were obese. Obese patients had a significantly higher risk of positive pressure ventilation use compared with nonobese patients (13.6% versus 8.8%), with a corresponding adjusted odds ratio of 1.61 (95% confidence interval, 1.55-1.68; <0.001). Likewise, obese patients were more likely to have hospital length of stay of ≥4 days compared with nonobese patients (62.5% versus 56.7%), with an adjusted odds ratio of 1.40 (95% confidence interval, 1.37-1.44; <0.001). In contrast, obese patients had significantly lower in-hospital mortality compared with nonobese patients (1.7% versus 3.3%), with an adjusted odds ratio of 0.87 (95% confidence interval, 0.80-0.95; =0.002).
Based on large population-based data sets of patients with HF exacerbation, obesity was associated with higher acute severity measures but lower in-hospital mortality.
肥胖和心力衰竭（HF）是美国的重要公共卫生问题。尽管研究报告了肥胖与 HF 慢性发病率升高之间的关联，但对于肥胖与 HF 加重的严重程度和住院死亡率之间的关系知之甚少；因此，我们旨在研究肥胖与 HF 加重的严重程度和住院死亡率之间的关系。
这项回顾性队列研究纳入了 2012 年至 2013 年美国 7 个州基于人群的住院患者数据（州住院患者数据库），研究对象为因 HF 加重而住院的成年人。研究结局为急性严重程度指标（使用正压通气和住院时间）和住院死亡率。我们确定了肥胖与这些结局之间的关系，包括对社会人口统计学因素和合并症的调整。我们确定了 219465 例因 HF 加重而住院的患者。其中，37539 例（17.1%）肥胖。与非肥胖患者相比，肥胖患者使用正压通气的风险显著更高（13.6%比 8.8%），相应的调整后比值比为 1.61（95%置信区间，1.55-1.68；<0.001）。同样，与非肥胖患者相比，肥胖患者的住院时间≥4 天的可能性更高（62.5%比 56.7%），调整后比值比为 1.40（95%置信区间，1.37-1.44；<0.001）。相比之下，肥胖患者的住院死亡率明显低于非肥胖患者（1.7%比 3.3%），调整后比值比为 0.87（95%置信区间，0.80-0.95；=0.002）。
基于 HF 加重患者的大型基于人群的数据集，肥胖与更高的急性严重程度指标相关，但与住院死亡率降低相关。
