Partial obesity paradox regarding mortality in patients hospitalized with diastolic or systolic heart failure.

Introduction: A phenomenon known as the obesity paradox has been reported in patients with heart failure (HF). The goal of this study is to characterize this observation in systolic (SHF) and diastolic (DHF) HF.

Methods and results: We used the National Inpatient Sample (NIS) database for 2016-2020. We evaluated mortality based on body weight. A total of 7,364,023 with SHF and 10,064,223 with DHF were found in the NIS database. All-cause inpatient mortality was lowest in overweight followed by obesity and morbid obesity, whereas mortality was highest in cachexia for SHF and DHF (mortality: overweight 2.56%, obese 3.12%, morbidly obese 3.70%, normal weight 5.60%, and cachexia 15.22%; p < 0.001) and DHF patients (mortality: overweight 2.08%, obese 2.43%, morbidly obese 2.93%, normal weight 4.58%, and cachexia 14.25%; p < 0.001). This relationship remains similar after multivariate analysis (SHF patients: overweight OR: 0.49 (0.41-0.58), obesity OR: 0.64 (0.62-0.66), morbid obesity OR: 0.85 (0.83-0.88), and cachexia OR: 2.78 (2.67-2.90); p < 0.001; DHF patients: overweight OR: 0.47 (0.40-0.56), obesity OR: 0.61 (0.59-0.63), morbid obesity OR: 0.83 (0.81-0.85), and cachexia OR: 3.09 (2.96-3.23); p < 0.001).

Conclusions: All-cause inpatient mortality in SHF and DHF is lowest in overweight populations followed by obese and morbidly obese populations, whereas cachexia has the highest mortality.