https://doi.org/10.1007/s00392-025-02625-4
1Universitätsklinikum Mannheim GmbH I. Medizinische Klinik Mannheim, Deutschland; 2Universitätsklinikum Frankfurt Med. Klinik III - Kardiologie, Angiologie Frankfurt am Main, Deutschland; 3Klinikum Sankt Georg Klinik für Kardiologie, Angiologie und intern. Intensivmedizin Leipzig, Deutschland; 4HELIOS Klinikum Krefeld Medizinische Klinik I Krefeld, Deutschland; 5Universitätsklinikum Münster Klinik für Kardiologie II - Rhythmologie Münster, Deutschland; 6Kath. Klinikum Bochum Kardiologie und Rhytmologie Bochum, Deutschland; 7Universitätsklinikum Bonn Medizinische Klinik und Poliklinik II Bonn, Deutschland; 8Berufsgenossenschaftlliches Universitätsklinikum Bergmannsheil gGmbH Medizinische Klinik II, Kardiologie und Angiologie Bochum, Deutschland; 9Klinikum der Ruhr-Universität Bochum Medizinische Klinik II, Kardiologie Bochum, Deutschland
Background
Obesity is a known risk factor for cardiovascular disease (CVD), yet an ‘obesity paradox’ has been observed in various CVD contexts. The impact of obesity on heart failure (HF) patients treated with a wearable cardioverter defibrillator (WCD) remains underexplored.
Methods
In a multicenter international registry, we retrospectively collected data from a consecutive series of 1003 patients. These patients were divided into three body mass index (BMI) groups: <25 kg/m2 (n = 348), 25-30 kg/m2 (n = 383), and >30 kg/m2 (n = 272), with BMI >30 kg/m2 defined as the reference category. Demographics, indications, adherence, WCD shocks, arrhythmic events, rehospitalization due to cardiovascular causes, and mortality were analyzed.
Results
At 3-month follow-up, patients with a BMI >30 showed the greatest improvement in left ventricular ejection fraction (LVEF) at 51.4%, significantly higher than the 41.4% in those with a BMI <25 (p=0.017), and comparable to the 49.4% in the BMI 25-30 group (p=0.635). WCD wearing time and adherence were similar across all BMI groups. The incidence of WCD shock was similar across BMI groups. Rates of ventricular tachycardia (VT), ventricular fibrillation (VF), and non-sustained VT (ns-VT) were comparable across BMI groups. The rate of implantable cardioverter-defibrillator (ICD) implantation was 40.3% across all patients, with a slightly lower rate in the BMI >30 group (36.8%) compared to others, though not significantly. Rehospitalization due to cardiovascular causes was significantly lower in the BMI >30 group (55.4%) compared to the BMI 25-30 group (70.9%; p=0.048), but similar to the BMI <25 group (54.9%; p=0.957). At 2-year follow-up, mortality was lower in the BMI >30 group (5.9%) compared to the BMI <25 (7.5%; p=0.029) and BMI 25-30 groups (7%; p = 0.681). In multivariable analysis, LVEF at long-term was significantly associated with a reduction in mortality.
Conclusions
Obese patients exhibited significantly greater improvement in LVEF, which was associated with reduced mortality. Adherence to WCD therapy was excellent across all BMI groups. ICD implantation occurred in 40.3% of patients, with similar WCD shock rates and arrhythmic events across BMI groups. An obesity paradox was observed, with obese patients demonstrating significantly lower rehospitalization rates due to cardiovascular causes and reduced mortality at follow-up.
Table legends
Table 1: Baseline characteristics of the cohort.
Table 2: Indications for WCD.
Table 3: WCD data.
Table 4: Clinical outcomes and CIED-implantation at follow-up.
Table 5: Multivariable logistic regression analysis for mortality.