The aim of this study was to assess heart failure (HF) treatment in patients with and without obesity in a large contemporary real-world Western European cohort.
Patients with a left ventricular ejection fraction (LVEF) <50% and available information on body mass index (BMI) were selected from the CHECK-HF registry. The CHECK-HF registry included chronic HF patients in the period between 2013 and 2016 in 34 Dutch outpatient clinics. Patients were divided into BMI categories. Differences in HF medical treatment were analyzed and multivariable logistic regression analysis (dichotomized as BMI < 30 kg/m and ≥ 30 kg/m ) was performed.
7671 patients were included, 1284 (16.7%) had a BMI ≥30 kg/m , and 618 (8.1%) had a BMI ≥35 kg/m . Median BMI was 26.4 kg/m . Patients with obesity were younger and had a higher rate of comorbidities such as diabetes mellitus, hypertension and obstructive sleep apnea (OSAS). Prescription rates of guideline-directed-medical therapy (GDMT) increased significantly with BMI. The differences were most pronounced for mineralocorticoid receptor antagonists (MRAs) and diuretics. Patients with obesity more often received the guideline-recommended target dose. In multivariable logistic regression, obesity was significantly associated with a higher likelihood of receiving ≥100% of the guideline-recommended target dose of beta-blockers (OR 1.34, 95% CI 1.10-1.62), renin-angiotensine-system (RAS)-inhibitors (OR 1.34, 95% CI 1.15-1.57) and MRAs (OR 1.40, 95% CI 1.04-1.87) CONCLUSIONS: Guideline recommended HF drugs are more frequently prescribed and at higher dose in patients with obesity as compared to HF patients without obesity.

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