Amiodarone, good, bad and mean

Abstract

Objective: Obesity paradox holds the improved survival of obese elderly or diseased patients. Obesity paradox has been extensively studied in heart failure. Although, in the last ten years, many studies have shown a better survival rate related to obesity, the reasons of the paradox are poorly explained. It is not clear why obese heart failure patients have a better survival rate being overweight as a well know vascular risk factor. Moreover, coronary disease is the first cause of heart failure and obesity is a long term risk factor to develop heart failure. Most studies about obesity paradox, even those including multivariate analysis, consider body mass index (BMI) as the only nutritional parameter, and prognosis is controlled by other vascular risk factors. The goal of our study was to investigate the prognostic value of changes in anthropometrics in a cohort of heart failure elderly patients. Methods: We studied a cohort of 244 patients hospitalized with heart failure (diagnosed according to Framingham criteria) at the Internal Medicine unit of a country hospital of Cantabria (Tres Mares Hospital at Reinosa); 115 were men and 129 women with an age range of 55 to 100 years (median age and quartiles of 85 and 79–89 years). Fourteen (5.7%) patients died during hospitalization. All patients were followed up by telephone with a median survival of 984 days. In order to assess prognostic value of changes in anthropometrics (body mass index (BMI), mid arm circumference (MAC), the triceps skinfold (TSF) by a Holtain lipocaliper and calculated the mid arm muscle area (MAMA)), we performed variance analysis with repeated measures of three clinical assessments performed in 6 month intervals.Results:We found that those patients who finally died showed significantly decreased BMI, MAC and MAMA when compared with those who survived, whereas the variations of TSF regarding final survival were not significant. Those patients who died during follow-up showed a progressive and significant decrease in BMI (27.39 kg/m to 26.01 kg/m) compared with those who survived and maintained their weight (27.80 kg/m to 27.86 kg/m). The same occurred with MAC and MAMA, whereas the variations in the TSF in relation to final survival were not significant. Conclusion: Our results stressed the importance of muscle mass regarding survival, which is probably higher than of fat in elderly heart failure patients.