In the Journals

Bariatric surgery reduces rate of HF exacerbation

Obese patients with HF who underwent bariatric surgery experienced a 40% reduction in the rate of hospitalizations or ED visits related to HF exacerbation, according to new data published in the Journal of the American College of Cardiology.

Researchers conducted a self-controlled case series study to investigate whether bariatric surgery reduces exacerbation of HF in patients with HF and obesity. The study included 524 patients from the Healthcare Cost and Utilization Project State Emergency Department Database and State Inpatient Database of California, Florida and Nebraska. The median age of the cohort was 49 years and more than half of the patients were women.

The primary outcome was hospitalizations or ED visits due to HF exacerbation between 2005 and 2011 using the population-based ED and inpatient sample in California, Florida and Nebraska.
The rate of ED visits or hospitalizations for HF exacerbation was 16.2% in the 13 to 24 months (reference period) leading up to bariatric surgery. In the 12 months leading up to surgery, the rate was unchanged at 15.3% (P = .67). The rate declined to 12% in the first 12 months after bariatric surgery (P = .052) and to 9.9% (adjusted OR = 0.57; P = .003) in the subsequent 13 to 24 months after bariatric surgery, according to the findings. The researchers compared these rates to those of obese patients who underwent non-bariatric surgeries such as cholecystectomy or hysterectomy and found no significant reduction in the rate of HF exacerbation.

“This self-controlled case series study using the largest dataset of patients with HF who underwent bariatric surgery showed that the rate of ED visits or hospitalizations for HF exacerbation was reduced by 40% after bariatric surgery,” Yuichi J. Shimada, MD, MPH, from the cardiology division of Massachusetts General Hospital and Harvard Medical School, and colleagues wrote. “... The present study provides the best evidence on the effectiveness of substantial weight loss on HF morbidity.”

Costs and complications of bariatric surgery may preclude some patients with HF and obesity from undergoing the procedure. The researchers recommended non-surgical strategies to achieve weight reduction in this population.

In a related editorial, Amanda R. Vest, MBBS, MPH, from the division of cardiology, Tufts Medical Center, Philip R. Schauer, MD, from the Bariatric and Metabolic Institute, Cleveland Clinic, and Cardiology Today Section Editor James B. Young, MD, from the Endocrinology and Metabolism Institute and Heart and Vascular Institute, Cleveland Clinic, noted that this study is “a very important first step in determining whether bariatric surgery or other weight-loss interventions relieve the burden of illness experienced by HF patients who are obese.”

Vest and colleagues suggested that future steps should include a prospective, randomized controlled trial in which bariatric surgery is compared with standard HF management for obese patients with HF. – by Tracey Romero

D isclosures: Schauer reports grant support/consulting for Ethicon and Medtronic; receiving research grants from Paciria; stock options and serving on the advisory board of SurgiQuest; and serving on the board of directors of SE Quality Healthcare Consulting. Shimada reports receiving support from the American Heart Association National Clinical and Population Research Award and the Honjo International Scholarship Foundation. Please see full study for a list of all other researchers’ relevant financial disclosures. Vest reports consulting for Amgen and Sunshine Heart Inc., without reimbursement. Young reports no relevant financial disclosures.

Obese patients with HF who underwent bariatric surgery experienced a 40% reduction in the rate of hospitalizations or ED visits related to HF exacerbation, according to new data published in the Journal of the American College of Cardiology.

Researchers conducted a self-controlled case series study to investigate whether bariatric surgery reduces exacerbation of HF in patients with HF and obesity. The study included 524 patients from the Healthcare Cost and Utilization Project State Emergency Department Database and State Inpatient Database of California, Florida and Nebraska. The median age of the cohort was 49 years and more than half of the patients were women.

The primary outcome was hospitalizations or ED visits due to HF exacerbation between 2005 and 2011 using the population-based ED and inpatient sample in California, Florida and Nebraska.
The rate of ED visits or hospitalizations for HF exacerbation was 16.2% in the 13 to 24 months (reference period) leading up to bariatric surgery. In the 12 months leading up to surgery, the rate was unchanged at 15.3% (P = .67). The rate declined to 12% in the first 12 months after bariatric surgery (P = .052) and to 9.9% (adjusted OR = 0.57; P = .003) in the subsequent 13 to 24 months after bariatric surgery, according to the findings. The researchers compared these rates to those of obese patients who underwent non-bariatric surgeries such as cholecystectomy or hysterectomy and found no significant reduction in the rate of HF exacerbation.

“This self-controlled case series study using the largest dataset of patients with HF who underwent bariatric surgery showed that the rate of ED visits or hospitalizations for HF exacerbation was reduced by 40% after bariatric surgery,” Yuichi J. Shimada, MD, MPH, from the cardiology division of Massachusetts General Hospital and Harvard Medical School, and colleagues wrote. “... The present study provides the best evidence on the effectiveness of substantial weight loss on HF morbidity.”

Costs and complications of bariatric surgery may preclude some patients with HF and obesity from undergoing the procedure. The researchers recommended non-surgical strategies to achieve weight reduction in this population.

In a related editorial, Amanda R. Vest, MBBS, MPH, from the division of cardiology, Tufts Medical Center, Philip R. Schauer, MD, from the Bariatric and Metabolic Institute, Cleveland Clinic, and Cardiology Today Section Editor James B. Young, MD, from the Endocrinology and Metabolism Institute and Heart and Vascular Institute, Cleveland Clinic, noted that this study is “a very important first step in determining whether bariatric surgery or other weight-loss interventions relieve the burden of illness experienced by HF patients who are obese.”

Vest and colleagues suggested that future steps should include a prospective, randomized controlled trial in which bariatric surgery is compared with standard HF management for obese patients with HF. – by Tracey Romero

D isclosures: Schauer reports grant support/consulting for Ethicon and Medtronic; receiving research grants from Paciria; stock options and serving on the advisory board of SurgiQuest; and serving on the board of directors of SE Quality Healthcare Consulting. Shimada reports receiving support from the American Heart Association National Clinical and Population Research Award and the Honjo International Scholarship Foundation. Please see full study for a list of all other researchers’ relevant financial disclosures. Vest reports consulting for Amgen and Sunshine Heart Inc., without reimbursement. Young reports no relevant financial disclosures.