Comparison of clinical characteristics according to Body mass index categories in patients with heart failure

Abstract

Background Body mass index (BMI) is an important modifier of clinical phenotype in patients with heart failure (HF). However, the relationship between BMI categories and baseline clinical characteristics across different HF phenotypes remains incompletely characterized. This study aimed to compare demographic and clinical characteristics according to BMI categories in a contemporary HF cohort. Purpose To examine the relationship between BMI categories and baseline demographic and clinical characteristics across distinct HF phenotypes. Methods This cross-sectional analysis included 947 patients with heart failure enrolled in a multicenter registry. Patients were classified into five BMI categories according to standard BMI definitions (WHO criteria). Analyses were stratified by HF phenotype: heart failure with reduced ejection fraction (HFrEF), mildly reduced ejection fraction (HFmrEF), and preserved ejection fraction (HFpEF). Baseline demographics, comorbidities, hospitalization history, emergency department (ED) admissions, NYHA functional class, and treatment-related variables were compared across BMI categories. Results In the HFrEF group, BMI categories were significantly associated with hypertension (p = 0.013) and diabetes mellitus (p = 0.048), with a higher prevalence of both comorbidities observed in higher BMI categories. No significant differences were identified across BMI groups regarding prior hospitalization, ED admission, NYHA functional class, or oral diuretic dose escalation. In the HFmrEF group, baseline clinical characteristics, including comorbidities, hospitalization status, ED admissions, and functional class, did not differ significantly across BMI categories. In contrast, within the HFpEF, being morbidly obese, obese or owerweight were significantly related with emergency department admission rates (p = 0.023) and female gender (p = 0.025). A borderline relation was observed between BMI and oral diuretic dose escalation (p = 0.053, Table 1). Other clinical characteristics were comparable across BMI categories. Conclusion BMI categories are associated with distinct clinical profiles in patients with HF, and vary by HF phenotype. While higher BMI is linked to a greater burden of hypertension and diabetes in HFrEF, increased emergency department admission and sex-related differences are more prominent in HFpEF. These findings highlight the importance of phenotype-specific assessment when interpreting the clinical implications of BMI in HF populations. For image description, please refer to the figure legend and surrounding text.