Impact of BMI on Clinical Outcomes and Readmissions After Cardiac Catheterization in the USA: The Obesity Paradox is Bigger than Ever Afnan R. Tariq MD 1,2 , A. Mantha MS 2 , A.N. Sharma 2 1 Lenox Hill Hospital, New York, NY, 2 University of California, Irvine, USA
Declaration of Interest • None
Background ‘‘Obesity Paradox’’ in coronary artery disease – Obese patients are at greater risk for developing CAD – However, studies have suggested that obese patients have better clinical outcomes after developing heart disease
Methods National Readmission Database, 2013, part of Health Care Utilization Project (HCUP, including Nationwide Inpatient Sample Database) 35 million hospitalizations across United States All-payer, publically available database ICD 9 CM codes for diagnosis and procedures/treatment 30 Day Readmission Statistical Analysis Survey weighted estimation Chi squared test of proportions Multi-level mixed models for hospital variability
Results Patients Undergoing PCI by BMI UW NL OW OB MO P value Total 1,074 356,237 3,052 48,282 26,846 - Female <0.001 55% 31% 31% 35% 46% <0.01 Elixhauser Comorbidity 5.05 2.81 3.76 4.03 4.56 Percent of Cath patients 25.8% 43.2% 41% 41% 32.5% <0.001 receiving PCI Income Low 63% 56% 57% 57% 62% <0.001 High 37% 44% 43% 43% 38%
Results Mortality and Readm ission after LHC 0.7% 25% 0.6% 20% % Readm ission 0.5% % Mortality 15% 0.4% 0.3% 10% 0.2% P<0.001 P<0.001 5% 0.1% 0.0% 0% UW NW OW OB MO Mortality Readmission Adj. Odds of P< 0 .0 5 1 .1 8 Ref. 0 .9 0 0 .8 9 0 .9 2 Readm ission
Results Cost and Length of Stay After LHC $40000,0 12 $35000,0 10 $30000,0 8 $25000,0 $20000,0 6 $15000,0 4 $10000,0 2 $5000,0 $,0 0 UW NW OW OB MO P<0.001 Cost ($) Length of Stay (days) P<0.001
Conclusions • Underweight patients were the most likely to die, most likely to be readmitted, and had the longest and most expensive hospitalizations • Obesity does not necessarily portend a worse outcome in patients undergoing cardiac catheterization – Obese patients had lower mortality and readmissions than normal weight patients • Further investigation is needed to define the role of BMI in the assessment of cardiovascular outcomes
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