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Heart failure and bariatric surgery

Mortality from heart failure reduced by 50% in bariatric patients

In-hospital mortality rates after heart failure were 50 percent less in the bariatric surgery group than either of the control groups (0.96% vs. 1.86%)

Patients who have previously undergone bariatric surgery and later suffer unrelated heart failure, cut their risk of dying in half compared to those who did not have surgery, according to a study from Cleveland Clinic researchers who presented their findings at ObesityWeek 2018, hosted by the American Society for Metabolic and Bariatric Surgery (ASMBS) and The Obesity Society (TOS).

Researchers reviewed data on 33,720 patients who were admitted to the hospital for heart failure between 2007 and 2014 and compared outcomes between those with and without a history of prior bariatric surgery. The surgery group included 2,810 patients and two control groups of 14,050 patients each, one limited to patients with a BMI>35 and the other consisting of patients of all BMIs. Data was obtained from the National Inpatient Sample (NIS), the largest all-payer inpatient healthcare database. On average, patients were 61-years-old and approximately 60 percent were women.

In their presentation, ‘Bariatric Surgery Decreases Mortality of Congestive Heart Failure: A Nationwide Study’ (Abstract no. 105), the researchers noted that in-hospital mortality rates after heart failure were 50 percent less in the bariatric surgery group than either of the control groups (0.96% vs. 1.86%) and the surgical patients spent about one less day in the hospital.

Ali Aminian

“A 50 percent reduction in in-hospital all-cause mortality is an unprecedented finding. There appears to be a significant protective and survival benefit after bariatric surgery even if patients later develop heart failure,” said Dr Ali Aminian, lead study author and associate professor of surgery at the Cleveland Clinic, Ohio. “The mechanism by which bariatric surgery affects heart failure is still under investigation, but this study suggests that some cardiac improvements may occur independent of weight loss.”

According to the American Heart Association, obesity increases the risk of heart disease. The group cites research from the Framingham Heart Study that found that people with obesity “had an incredible 104% increase in the risk of developing heart failure compared to non-overweight individuals.” Heart failure accounts for more than 1 million hospitalisations in the US annually and is the leading cause of hospitalization for adults over the age of 65.

Samer Mattar

“While improvement in cardiovascular risk factors after bariatric surgery is well documented, this study shows should a cardiac event like heart failure occur, the chances of survival are much higher for bariatric surgery patients than patients with severe obesity who do not undergo an operation,” said Dr Samer Mattar, president, ASMBS and medical director at Swedish Weight Loss Services in Seattle Washington, who was not involved in the study.

The CDC reports 93.3 million or 39.8 percent of adults in the US had obesity in 2015-2016. The ASMBS estimates about 24 million have severe obesity, which for adults means a BMI>35 with an obesity-related condition like diabetes or a BMI of 40 or more. In 2017, 228,000 bariatric procedures were performed in the US, which is about 1 percent of the population eligible for surgery based on BMI.

The co-authors of the paper included Drs Essa M Aleassa, Zhamak Khorgami, Chao Tu, Philip R Schauer and Stacy Brethauer, all from Cleveland Clinic.

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