The Relationship Between Body Mass Index and In-hospital Survival in Patients Admitted With Acute Heart Failure

Gabby Elbaz-Greener, Guy Rozen, Shemy Carasso, Merav Yarkoni, Harindra C. Wijeysundera, Ronny Alcalai, Israel Gotsman, Eldad Rahamim, David Planer, Offer Amir

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1 Scopus citations


Background: The association between Body Mass Index (BMI) and clinical outcomes following acute heart failure (AHF) hospitalization is debated in the literature. Our objective was to study the real-world relationship between BMI and in-hospital mortality in patients who were admitted with AHF. Methods: In this retrospective, multi-center study, we utilized the National Inpatient Sample (NIS) database to identify a sampled cohort of patients who were hospitalized with AHF between October 2015 and December 2016. Outcomes of interest included in-hospital mortality and length of stay (LOS). Patients were divided into 6 BMI (kg/m2) subgroups according to the World Health Organization (WHO) classification: (1) underweight ≤ 19, (2) normal weight 20–25, (3) overweight 26–30, (4) obese I 31–35, (5) obese II 36–39, and (6) extremely obese ≥40. A multivariable logistic regression model was used to identify predictors of in-hospital mortality and to identify predictors of LOS. Results: A weighted total of 219,950 hospitalizations for AHF across the US were analyzed. The mean age was 66.3 ± 31.5 years and most patients (51.8%) were male. The crude data showed a non-linear complex relationship between BMI and AHF population outcomes. Patients with elevated BMI exhibited significantly lower in-hospital mortality compared to the underweight and normal weight study participants (5.5, 5,5, 2,8, 1.6, 1.4, 1.6% in groups by BMI ≤ 19, 20–25, 26–30, 31–35, 36–39, and, ≥40 respectively, p < 0.001) and shorter LOS. In the multivariable regression model, BMI subgroups of ≤ 25kg/m2 were found to be independent predictors of in-hospital mortality. Age and several comorbidities, and also the Deyo Comorbidity Index, were found to be independent predictors of increased mortality in the study population. Conclusion: A reverse J-shaped relationship between BMI and mortality was documented in patients hospitalized for AHF in the recent years confirming the “obesity paradox” in the real-world setting.

Original languageEnglish
Article number855525
JournalFrontiers in Cardiovascular Medicine
StatePublished - 28 Apr 2022

Bibliographical note

Publisher Copyright:
Copyright © 2022 Elbaz-Greener, Rozen, Carasso, Yarkoni, Wijeysundera, Alcalai, Gotsman, Rahamim, Planer and Amir.


  • AHF
  • BMI
  • acute heart failure
  • body mass index
  • outcome


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