Incidence of atrial and ventricular arrhythmias in obese patients with heart failure with reduced ejection fraction treated with sacubitril/valsartan

Abstract

AbstractAimTo compare clinical outcomes among patients with heart failure and reduced ejection fraction (HFrEF) according to body mass index (BMI) after initiating treatment with an angiotensin‐receptor neprilysin inhibitor (ARNI).MethodsWe gathered data from 2016 to 2020 at the University Medical Center Mannheim; 208 consecutive patients were divided into two groups according to BMI (< 30 kg/m2; n = 116, ≥ 30 kg/m2; n = 92). Clinical outcomes, including mortality rate, all‐cause hospitalizations and congestion, were systematically analysed.ResultsAt the 12‐month follow‐up, the mortality rate was similar in both groups (7.9% in BMI < 30 kg/m2 vs. 5.6% in BMI ≥ 30 kg/m2; P = .76). All‐cause hospitalization before ARNI treatment was comparable in both groups (63.8% in BMI < 30 kg/m2 vs. 57.6% in BMI ≥ 30 kg/m2; P = .69). After ARNI treatment, the hospitalization rate was also comparable in both groups at the 12‐month follow‐up (52.2% in BMI < 30 kg/m2 vs. 53.7% in BMI ≥ 30 kg/m2; P = .73). Obese patients experienced more congestion compared with non‐obese patients at follow‐up, without statistical significance (6.8% in BMI < 30 kg/m2 vs. 15.5% in BMI ≥ 30 kg/m2; P = .11). Median left ventricular ejection fraction (LVEF) improved in both groups, but significantly more in non‐obese compared with obese patients at the 12‐month follow‐up (from 26% [3%‐45%] [min.‐max.] vs. 29% [10%‐45%] [min.‐max.] [P = .56] to 35.5% [15%‐59%] [min.‐max.] vs. 30% [13%‐50%] [min.‐max.] [P = .03], respectively). The incidence of atrial fibrillation (AF), non‐sustained (ns) and sustained ventricular tachycardia (VT) and ventricular fibrillation (VF) was less in non‐obese than in obese patients after initiation of sacubitril/valsartan at the 12‐month follow‐up (AF: 43.5% vs. 53.7%; P = .20; nsVT: 9.8% vs. 28.4%; P = .01; VT: 14.1% vs. 17.9%; P = .52; VF: 7.6% vs. 13.4%; P = .23).ConclusionsThe incidence of congestion in obese patients was higher compared with non‐obese patients. LVEF improved significantly more in non‐obese compared with obese HFrEF patients. Furthermore, AF and the ventricular tachyarrhythmia rate were revealed more in obesity compared with those without obesity at the 12‐month follow‐up.