Effect of Body Mass Index on Mortality In Patients with Heart Failure with Reduced Ejection Fraction Receiving Sacubitril/ Valsartan

Abstract

Introduction The post-hoc study of Valsartan Heart Failure Trial (Val-He-FT) evaluated the effect of body mass index (BMI) on clinical outcomes in patients with HFrEF receiving valsartan. It showed a decrease in mortality rate with increasing BMI. However, limited data is available for the effect of BMI on mortality rate in patients with HFrEF receiving sacubitril/valsartan. The aim of the project is to assess the relationship between BMI and clinical outcomes in patients with HFrEF receiving sacubitril/valsartan. Methods Patients receiving sacubitril/valsartan diagnosed as HFrEF from July 2015 to December 2019 were included in this retrospective cohort study. Patients receiving sacubitril/valsartan less than 1 year and receiving dialysis were excluded. The whole cohort was divided into three groups based on BMI: normal weight group (BMI greater than or equal to 24.9), overweight group (25 greater than or equal to BMI less than or equal to 29.9) and obese group (30 greater than or equal to BMI). The primary outcome was all-cause mortality. The follow-up period was up to 3.5 years after sacubitril/valsartan initiation. Multiple logistic regression analysis was conducted with hazard ratios and their 95% confidence intervals (CIs). Prespecified variables included age, brain natriuretic peptide, creatinine, ejection fraction, gender, sacubitril/valsartan dose, systolic blood pressure, and prior angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blocker (ARB) use. The significant level was set at 0.05. Results A total of 66 patients in the normal-weight group, 92 patients in the overweight group and 162 patients in the obese group was included in this preliminary analysis. There were no significant differences in mortality rates between normal weight and obese groups (24.24 vs. 18.52%; HR 1.57; 95% CI 0.85-2.88), and overweight and obese groups (18.48 vs. 18.52%; HR 1.10; 95% CI 0.61-1.99). After controlling for the pre-specified variables, no significant difference in mortality rate was retained between normal weight and obese groups (HR 0.19; 95% CI 0.02-1.55), and overweight and obese groups (HR 0.49; 95% CI 0.10-2.36). Conclusions This preliminary analysis shows that no association exists between BMI and mortality rate in patients with HFrEF receiving sacubitril/valsartan. The final analysis with a larger sample size will be needed for further investigation.