The Association of BMI and Diabetes Mellitus with Mortality in End Stage Heart Failure Patients on Inotropes

Abstract

Risk factors such as diabetes mellitus (DM) have been associated with increased risk of mortality in patients with heart failure (HF). Obesity in diabetic patients worsens outcomes. However, there appears to be an obesity paradox in which stable HF patients with higher body mass index (BMI) have better survival. We sought to evaluate the association of DM and BMI with mortality in patients with end stage HF on palliative inotropic therapy. We performed a single center, retrospective chart review of HF patients who were placed on inotropes (milrinone or dobutamine) as palliative therapy from January 1, 2010 and followed up until October 1, 2019. Patients who received mechanical circulatory support or heart transplant were excluded. Patients were categorized by BMI (<25Kg/m2, 25-35Kg/m2 and >35Kg/m2). The primary outcome was all cause mortality. Multivariate cox proportional hazard regression model was used for analysis. 115 patients were included. Unadjusted analysis revealed significant relationship between mortality and coronary artery disease (HR 1.981; p value 0.01) and ischemic cardiomyopathy (HR 1.941; p value 0.01). After adjusting baseline characteristics using multivariate analysis (Table 1), mortality was associated with DM (p value 0.04) and history of CABG (p value 0.03). There was no significant association between mortality and BMI in either unadjusted or adjusted models. When entered as a continuous value, creatinine level (p value 0.02) was a predictor for mortality in both models. In patients with end stage HF on inotropic therapy, DM and worsening renal function are associated with increased mortality. BMI does not appear to affect mortality in these patients. Our small sample size was a significant limitation. More studies are needed to further characterize risk factors and help determine which patients would derive the most benefit from palliative inotropic therapy if they are not candidates, or do not desire advanced HF therapies.