Obesity as a Risk Factor for Consideration for Left Ventricular Assist Devices

Abstract

Background: Obesity is a major risk factor for cardiovascular outcomes and is prevalent in patients with advanced heart failure requiring left ventricular assist devices (LVADs). The understanding of high body mass index (BMI) and outcomes after LVAD implantation continues to evolve. In this study we investigated the effects of obesity on post-LVAD implantation outcomes.

Methods and results: In this retrospective study, 288 patients with both Heartmate II and Heartware HVADs, implanted as bridge to transplantation (BTT) and destination therapy (DT), were enrolled. Patients were stratified according to BMI ≥30 kg/m(2). Baseline demographics were obtained. Post-LVAD implantation incidence of readmissions and major adverse events were tabulated. The cohort comprised of 95 (33%) obese and 193 (67%) nonobese patients, as well as, 63 (25%) female and 225 (75%) male patients; 48 (20%) were implanted as BTT and 240 (80%) as DT. The mean BMI in the obese group was 35.2 kg/m(2) compared with 24.3 kg/m(2) (P < .001) in the control group. There was no difference in survival between the two groups. Incidence of post-LVAD implantation heart failure readmissions was higher in the obese cohort. (29% vs 16% P = .009). Multivariate analysis confirmed that BMI was an independent predictor for post-LVAD heart failure readmissions (odds ratio 2.47, 95% confidence interval 1.15-5.32; P = .02) Obese patients had a higher mean total number of hospitalizations compared with nonobese patients, (4.2 vs 3.4; P = .03) as well as higher median total length of stay after LVAD implantation (28 vs 14 days; P = .05), but these were not significant when adjusted for covariates.

Conclusions: Obese patients had higher incidence of post-LVAD implantation heart failure readmissions. There was no difference in overall survival or outcomes between the 2 groups. There was no difference in total rehospitalizations or length of stay between obese and nonobese patients. Our analysis suggests that obesity should not preclude LVAD candidacy.

Keywords: BMI; LVAD; Obesity; hospitalizations; left ventricular assist device; mortality; outcomes.