Metabolic surgery on patients with heart failure can result in a reduction in the need for oral diuretics, which are used to manage symptoms such as venous and vascular pressures, according to Pennington Biomedical Research Center researchers at the Metamor Institute, along with colleagues from Our Lady of the Lake and LSU Health-New Orleans, LA.
“The data unearthed in our study further expands the extended benefits of metabolic surgery, including for those with heart failure and heart disease,” said Dr Philip Schauer, Director of the Metamor Institute, located on the campus of Pennington Biomedical Research Center in Baton Rouge, and one of the researchers on the study. “With obesity as a commonly occurring factor in heart failure, the reduction in the use of diuretics following metabolic surgery aligns with similar studies on improvements in post-surgery quality of life. The Metamor Institute and Pennington Biomedical investigative teams are pleased to undertake research that provides further clarity into the benefits of obesity interventions.”
The authors hypothesised that metabolic surgery may reduce recurrence of heart failure symptoms. Researchers reviewed more than 2,300 hospital records of patients who underwent metabolic surgery between 2017 and 2023 and identified 63 of those patients with a diagnosis of heart failure prior to surgery. They sought to describe the cardiac and metabolic effects of BMS in patients with heart failure (HF) and hypothesised that patients with HF would experience both improved metabolic and HF profiles using glycaemic control and diuretic dependency as surrogate markers.
In this single-centre, university-affiliated academic study, the preoperative characteristics, 30-day outcomes and up to two-year biometric and metabolic outcomes, medication usage, and emergency department utilisation were collected. At 24 months (Figure 1), mean body mass index change was −16 kg/m2 (p<0.001) corresponding to a mean percentage total body weight loss of 29% (p<0.001). Weight loss was accompanied by significant reductions in haemoglobin A1c (p<0.001) and a 65% decrease in diuretic use at 24 months after surgery (p<0.001).
In addition, emergency visits for cardiac conditions (p=0.06) and intravenous diuresis (p=0.07) trended favourably at one year after surgery, compared with one year before surgery but were not statistically significant.
"With the high incidence of heart failure and obesity in South Louisiana, ongoing research like this is vital to stem the consequences of these diseases and improve the quality of life for our patients," said Dr Denzil Moraes, Chief Medical Director of the Heart and Vascular Institute at Our Lady of the Lake Regional Medical Center and co-lead author of the study.
The authors concluded that in patients with HF who were carefully selected, BMS appears to provide significant reduction in oral diuretic dependency, and metabolic improvements with trends toward lower rates of emergency department utilisation.
"While there are obvious benefits to metabolic intervention, I am proud that our team continues to affirm the safety of metabolic surgery, elaborate on its effectiveness and add to the long list of benefits such interventions provide," said Dr John Kirwan, Executive Director of Pennington Biomedical.
The outcomes were reported in the paper, ‘Clinical Outcomes of Metabolic Surgery on Diuretic Use in Patients With Heart Failure’, published in The American Journal of Cardiology. To access this paper, please click here (log-in maybe required)
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