Barriers to Weight Loss in a Heart Failure with Preserved Ejection Fraction Clinic

Abstract

Introduction Obesity is common in HFpEF, and likely contributes to its development and progression. Cohort studies and clinical trials suggest that weight loss is beneficial, but barriers to weight loss in this population may be substantial. Methods We performed a chart review of patients presenting to our HFpEF Clinic from 1/2015 to 9/2018. Obesity was defined as a body mass index ≥ 30 kg/m2. We evaluated physical activity using the Godin Leisure-Time Questionnaire. We evaluated for anxiety and depression with General Anxiety Disorder-7 (GAD7) and Patient Health Questionnaire-9 (PHQ9) scores. Pittsburgh Sleep Quality Index scores were used in combination with chart data to calculate risk of obstructive sleep apnea (OSA) using the STOP-BANG criteria. The Short Physical Performance Battery (SPPB) was used to assess frailty. Patient electronic medical records were reviewed for polysomnograms (PSG), outpatient nutrition consults, and bariatric surgery and cardiac rehabilitation referrals. Results We identified 127 obese HFpEF patients (61% female) with an average age of 69 ± 6.6 years. Comorbid conditions were common (85% hypertension, 70% hyperlipidemia, 59% diabetes mellitus). Of the 50 patients with adequate data to calculate a STOP-BANG score, 96% met criteria for high risk of OSA. All 35 patients that had a PSG tested positive for OSA. Barriers to weight loss were common including anxiety, depression, and frailty (see Table). Most did not meet the Government Advisory Committee recommended 500 MET-min/week and over half reported no exercise at all. The overall utilization of resources to facilitate weight loss was suboptimal. Fewer than one-third received an outpatient dietitian consultation. Less than half meeting criteria for bariatric surgery were offered the intervention. Three-quarters of patients with indications for cardiac rehabilitation were referred; however, many did not have Medicare-reimbursed indications. Conclusion Barriers to weight loss are highly prevalent in HFpEF, with many patients struggling with anxiety, depression, frailty, and decreased activity levels. Opportunities exist to facilitate weight loss and improve quality of life in HFpEF through multidisciplinary interventions to address these challenges.