Abstract 12343: Bariatric Surgery is Associated With Reduced Rate of Emergency Department Visits and Hospitalizations for Heart Failure Exacerbation Among Obese Patients With Heart Failure

Abstract

Introduction: Heart failure (HF) is a significant societal burden. Obesity is known as a possible risk factor for HF exacerbation. However, little is known as to whether weight loss interventions, such as bariatric surgery, effectively reduce the rate of HF exacerbation. Hypothesis: Bariatric surgery is associated with a reduction in the rate of ED visits and hospitalizations for HF exacerbation.. Methods: We performed a self-controlled case series study (each individual serves as his/her own control) of obese patients with HF who underwent bariatric surgery, using the population-based ED and inpatient sample in 3 states (California, Florida, and Nebraska). Primary outcome was ED visit or hospitalization for HF exacerbation from 2005 to 2011. We used conditional logistic regression to compare each patient's rate of the outcome event during sequential 12-month periods, using pre-surgery months 13-24 as the reference period. Results: We identified 1664 patients with HF who underwent bariatric surgery. During the reference period, 14.4% (95% CI, 12.7-16.0%) of patients had an ED visit or hospitalization for HF exacerbation (Figure). The rate remained unchanged in the subsequent 12-month pre-surgery period (13.3 [11.7-15.0]%); adjusted odds ratio (aOR) 0.92 [0.75-1.12]; P=0.39). In the first 12-month period after bariatric surgery, we observed a significantly lower rate of ED visits or hospitalizations for HF exacerbation (8.7 [7.4-10.1]%; aOR 0.56 [0.45-0.70]; P<0.0001). The rate remained significantly lower in the subsequent 13-24 months after bariatric surgery (8.7 [7.4-10.1]%; aOR 0.56 [0.45-0.70]; P<0.0001). In contrast, we did not observe a significant reduction in the rate of HF exacerbation with non-bariatric surgery (i.e., cholecystectomy, hysterectomy). Conclusions: Our findings indicate that bariatric surgery is associated with lower rates of HF exacerbations requiring ED evaluation or hospitalization among obese patients with HF.