2017 Resarch Forum

IM: M-2 Applicant & Principal Investigator: Ali Ammar MD

BMI as a predictor of 90 day readmission in heart failure patients with reduced ejection fraction

Ali Ammar MD, Jeffrey Coleman MS IV, Saman Ratnayake MD

INTRODUCTION Heart Failure (HF) is a serious, chronic, and progressive condition that may require hospitalization if decompensated. Each year, in the United States there are approximately 1 million hospitalizations due to decompensated HF, which costs approximately $39 billion annually. PURPOSE The objective of this study was to describe the frequency of hospital readmissions for patients with HF with respect to their BMI. METHOD In this retrospective study, 300 HF patients with low left ventricular ejection fraction (LVEF) and increased BMI (July, 2015 to July, 2016). Eligible patients were ≥65 years old, had an established diagnosis of HF, with LVEF <40%. The patients were divided into 3 groups: 100 patients with BMI < 30 (normal), 100 patients with BMI 30-40 (mild-moderate obesity), and 100 patients with BMI > 40 (severe obesity). Data was collected through uniform data query of a community hospital databases. Data were collected on patient demographics, medical history, laboratory findings, antihypertensive therapies, hospital associated events, readmission within 90 days of hospital discharge, and admission to ICU within 90 days, following the index hospitalization. RESULTS The 90-day readmission rate of all patients was 26% (78/300). Of those patients 10% (8/78) were readmitted more than once. Conversely, only 23% (23/100) of HF patients with BMI of 30-40 required readmission. Of those patients 4% (1/23) were readmitted more than once. Patients with a BMI of 30-40 had a significantly lesser overall readmission rate (P = <0.05). Patients with BMI < 30 had a readmission rate of 30% (30/100). Of those 10% (3/30) were readmitted more than once. Patients with a BMI >40 had a readmission rate of25% (25/100). Of those 8% (2/25) were readmitted more than once. Patients with a BMI >40 had a significantly lower readmission rate (P = < 0.05). DISCUSSION More than one third of patients discharged home after hospitalization for HF were re-hospitalized at least once within 90 days for heart failure exacerbation. The presence of mild to moderate obesity was significantly associated with a decreased readmission rate. The presence of severe obesity was associated with significant decreased readmissions when compared to normal BMI. Further studies are warranted to determine the impact of other variables on readmission rates and clinical outcomes in this population. CONCLUSIONS Obesity may be a protective factor for heart failure.