Impact of Body Mass Index on Activities of Daily Living in Inpatients with Acute Heart Failure

ObjectivesTo investigate the impact of body mass index on activities of daily living in inpatients with acute heart failure.DesignA retrospective cohort study.SettingA hospital-based database contains Diagnosis Procedure Combination survey data from 100 participating acute-care hospitals.Participants11,301 inpatients aged 20 year or older who were admitted to the participating hospitals with a diagnosis of acute heart failure.MeasurementsThe Barthel Index score at discharge and hospital death.ResultsThe number of patients with a body mass index of <18.5 kg/m2 (underweight), 18.5-22.9 kg/m(2) (low-normal weight), 23.0-24.9 kg/m(2) (high-normal weight), 25.0-29.9 kg/m(2) (overweight), and 30.0 kg/m(2) (obesity) were 1689 (15%), 4715 (42%), 1809 (16%), 2306 (20%), and 782 (7%), respectively. Median Barthel Index scores at admission and discharge were 65 and 100, respectively. Hospital death occurred in 101 (0.9%) patients. Lower body mass index was associated with lower Barthel Index score at discharge and higher mortality. Multivariable analysis adjusted for body mass index, age, sex, New York Heart Association classification, Barthel Index score at admission, the updated Charlson Comorbidity Index, length of hospital stay, number of drugs administered, and rehabilitation during hospitalization revealed that body mass index was independently associated with Barthel Index score at discharge (beta: 0.354; 95% confidence interval: 0.248-0.461) and hospital death (odds ratio: 0.926, 95% confidence interval: 0.877-0.978).ConclusionOverweight and obese inpatients showed greater independence in activities of daily living at discharge and lower rates of mortality, indicating the obesity paradox. A combination of rehabilitation and improved nutrition seems to be important in underweight patients with acute heart failure.