Practice Update - ESC Congress 2017

Underweight is Associated with Highest Mortality and Costs After Cardiac Catheterization Underweight is associated with higher mortality, cost, length of stay, and readmission rate compared with being overweight for patients undergoing cardiac catheterization, according to a new study. The findings were based on results of an analysis of more than 1 million patients, and were presented at the 2017 European Society of Cardiology (ESC) Congress, from August 26–30.

A fnan Raouf Tariq, MD, of Lenox Hill Hospital, New York, noted in a written release that, “Elevated body mass index (BMI) is a risk factor for coronary artery disease, yet studies have shown that overweight and obese patients experience fewer complications and better clinical outcomes after revascularization using percutane- ous coronary intervention (PCI) – a phenomenon dubbed the obesity paradox.” Furthermore, interest is growing in clinical out- comes and healthcare utilization of medically underweight (BMI <19 kg/m 2 ) patients. Dr. Tariq and colleagues set out to examine the association of BMI with in-hospital mortality, cost of care, length of stay, and rate of readmission within 30 days in patients undergoing cardiac catheterization in 2013 in a nationally representative cohort. The researchers used the National Readmission Database and Nationwide Inpatient Sample Database to retrospectively analyze discharge and readmission data. These databases are the larg- est all-payer USA inpatient databases and include more than 35 million annual hospitalizations. The team analyzed discharge data retrospec- tively for index admission, 30-day, and 6-month readmissions for patients undergoing cardiac cath- eterization throughout 2013. All-cause mortality, 30-day readmission, and cost at discharge were evaluated using chi-square test of proportions and patient-level weighted regression controlling for gender, age, insurance, and comorbidity measured by the Elixhauser Index. With that method, Dr. Tariq said, “We see how striking the differences really are, because it’s not

only that the obese patients do better, but also how much worse the underweight patients do. Underweight patients are five times more likely to die, and that’s something prior studies really didn’t differentiate out. They just looked at normal weight and obese.” While earlier studies looked at mortality in par- ticular, the current study also looked at hospital readmissions and associated costs. In 2013, 1,035,727 patients underwent cardiac cath- eterization, of which 42% of whom also received PCI with a stent or balloon. When categorized by BMI, 0.4% of patients were underweight (BMI <19 kg/m 2 ), 11.4% obese (BMI 30.1–40 kg/m 2 ), and 8.0% morbidly obese (BMI >40 kg/m 2 ). Of those undergoing cardiac catheterization, only 25.8% of underweight patients went on to receive PCI, whereas 32.5% of morbidly obese, 41% of over- weight, 41% of obese, and 43.2% of normal-weight categories went on to receive a PCI (all values P < .001 adjusted for comorbidities). Despite the low percentage of cardiac catheter- izations and lower rate of PCI than normal and overweight BMI groups, underweight patients were over three times more likely to die after cardiac catheterization than morbidly obese patients and

Dr. Afnan Raouf Tariq

PRACTICEUPDATE CONFERENCE SERIES • ESC Congress 2017 16