Body mass indices and outcome in patients with chronic heart failure

Aims There is an inverse relation between body mass and mortality in large populations of patients with chronic heart failure with a broad range of disease severity. The best measure of body size to describe the relation is not clear. Methods and results Patients with chronic heart failure (n = 2271, age 71.9 +/- 11.3 years; 74.6% male) due to left ventricular systolic dysfunction were followed for a median of 1785 days (inter-quartile range, 874-2311 days) in survivors. We measured body mass index (BMI: weight/height(2)), ponderal index (PI: weight/height(3)), and body surface area (BSA). In a subset of 1025 patients, we also calculated the 'Charles index' [weight/(waist(2) x height)] together with bioimpedance data. During follow-up, 912 patients died. Measures of body mass were strong univariable predictors of outcome, and BSA (chi(2) = 71.3) was the strongest predictor followed by height (chi(2) = 68.6), weight (chi(2) = 57.4), then BMI (chi(2) = 15.2). The larger the patient's size, the lower the risk of mortality. Body surface area was the single strongest predictor of outcome in a multivariable model including 14 variables. In the subset with bioimpedance data, basal metabolic rate, BSA, weight, BMI, percentage body fat, fat mass, PI, and fat-free mass were all univariable predictors of outcome. Conclusion Measures of body size are strongly related to outcome in patients with chronic heart failure. Body surface area is a stronger predictor of mortality than other measures of body habitus, irrespective of height correction. The greater the overall bulk of the body, the better the survival.