Impact of BMI on Clinical Outcomes and Readmissions After Cardiac - - PowerPoint PPT Presentation

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Aug 14, 2023 203 likes •298 views

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

SLIDE 1

Impact of BMI on Clinical Outcomes and Readmissions After Cardiac Catheterization in the USA:

The Obesity Paradox is Bigger than Ever Afnan R. Tariq MD1,2, A. Mantha MS2, A.N. Sharma2

1Lenox Hill Hospital, New York, NY, 2University of California, Irvine, USA

SLIDE 2

Declaration of Interest

None

SLIDE 3

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

SLIDE 4

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

SLIDE 5

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

55% 31% 31% 35% 46% <0.001

Elixhauser Comorbidity

5.05 2.81 3.76 4.03 4.56 <0.01

Percent of Cath patients receiving PCI

25.8% 43.2% 41% 41% 32.5% <0.001

Income Low

63% 56% 57% 57% 62% <0.001

High

37% 44% 43% 43% 38%

SLIDE 6

Results

0% 5% 10% 15% 20% 25% 0.0% 0.1% 0.2% 0.3% 0.4% 0.5% 0.6% 0.7% UW NW OW OB MO

% Readm ission % Mortality

Mortality and Readm ission after LHC

Mortality Readmission

P<0.001 P<0.001

Adj. Odds of

Readm ission 1 .1 8 Ref. 0 .9 0 0 .8 9 0 .9 2 P< 0 .0 5

SLIDE 7

Results

2 4 6 8 10 12 $,0 $5000,0 $10000,0 $15000,0 $20000,0 $25000,0 $30000,0 $35000,0 $40000,0 UW NW OW OB MO

Cost and Length of Stay After LHC

Cost ($) Length of Stay (days) P<0.001 P<0.001

SLIDE 8

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

Impact of BMI on Clinical Outcomes and Readmissions After Cardiac Catheterization in the USA:

The Obesity Paradox is Bigger than Ever Afnan R. Tariq MD1,2, A. Mantha MS2, A.N. Sharma2

Declaration of Interest

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)

Statistical Analysis

Results

Patients Undergoing PCI by BMI

UW NL OW OB MO P value Total

1,074 356,237 3,052 48,282 26,846

55% 31% 31% 35% 46% <0.001

Elixhauser Comorbidity

5.05 2.81 3.76 4.03 4.56 <0.01

Percent of Cath patients receiving PCI

25.8% 43.2% 41% 41% 32.5% <0.001

Income Low

63% 56% 57% 57% 62% <0.001

High

37% 44% 43% 43% 38%

Results

Mortality and Readm ission after LHC

Results

Cost and Length of Stay After LHC

Conclusions

likely to be readmitted, and had the longest and most expensive hospitalizations

in patients undergoing cardiac catheterization

– Obese patients had lower mortality and readmissions than normal weight patients

BMI in the assessment of cardiovascular outcomes