Obese Cardiac Patients Who Have Bariatric Surgery May See Reduction in Heart Failure Exacerbation Rate

Obese Cardiac Patients Who Have Bariatric Surgery May See Reduction in Heart Failure Exacerbation Rate

A new study led by Massachusetts General Hospital (MGH) researchers revealed that bariatric surgery is associated with a decline in the rate of heart failure exacerbation two years following the procedure. The study, “Bariatric Surgery and Emergency Department Visits and Hospitalization for Heart Failures Exacerbation,” was published in the Journal of the American College of Cardiology.

“We found that bariatric surgery – the most effective way to achieve substantial and sustained weight loss – was associated with a 40 percent reduction in emergency department visits and hospitalizations for heart failure exacerbation,” Yuichi Shimada, M.D., MPH, of the MGH Cardiology Division, the lead and corresponding author of the study, said in a news release.

“These findings are important because, while both obesity and heart failure are major public health problems in the U.S., little has been known about whether substantial weight loss would decrease the risk of heart failure-related adverse events,” Shimada said.

Heart failure affects approximately 5.7 million adults in the U.S., and about 40 percent of those hospitalized for heart failure exacerbation are obese. Previous studies have shown an increase in heart failure-related death in patients with obesity, and also that increased body fat can cause adverse changes in the shape and performance of the heart.

With the aim of investigating if there is an association between bariatric surgery and a decreased rate of heart failure  exacerbation, the team of researchers conducted a self-controlled case series of patients with obesity and heart failure who underwent bariatric surgery — a total of 524 patients. The researchers used the emergency department (ED) and inpatients database of records in Florida, California, and Nebraska. The study’s primary endpoint was ED visits or hospitalization for heart failure exacerbation from 2005 to 2011.

The researchers analyzed data covering the two years before and after each patient’s surgery, and compared the presurgical and postsurgical periods, essentially allowing patients to serve as their own controls, reducing the possibility that confounding factors could affect the results.

Throughout the reference period, 16.2 percent of the obese patients had an emergency room visit or hospitalization for heart failure exacerbation. The rate remained unchanged in the following 12-month pre-surgery period (15.3 percent). In the first 12-month period post-bariatric surgery, the results revealed a reduced rate (12 percent), however, this result was non-significant.

Conversely, the rate was significantly lower in the 13 to 24 months following bariatric surgery (9.9 percent). In contrast, the results showed no significant reduction in the rate of heart failure exacerbation among patients who underwent cholecystectomy and hysterectomy (non-bariatric surgery).

“These results imply that clinicians treating patients with both heart failure and morbid obesity should consider surgical weight reduction to help patients control the risk of heart-failure-related events; but it’s also true that some patients have other health problems that make the risks of surgery higher,” Shimada said. “In those cases, accurate assessment of the risks and benefits of surgery becomes critically important, and this study provides indispensable information for patients and treating physicians. It also will be essential to develop effective nonsurgical options to help such patients achieve substantial and sustained weight loss.”

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