(763) The Interaction of Nutritional Status and Body Mass Index on Outcomes after LVAD Implantation

PurposeMalnutrition and cardiac cachexia with low body mass index (BMI) are recognized pre-implant risk factors for adverse post-LVAD outcomes. The obesity paradox has defined a protective effect of higher BMI in terms of outcomes in heart failure (HF) patients. We evaluated the interaction of nutritional state (estimated by albumin) with BMI on LVAD outcomes.MethodsA retrospective cohort study of patients implanted with continuous flow LVAD at our center between 2006 and 2022 was performed. Patients were stratified into four quartiles based on nutritional status and BMI. We considered malnourished to be albumin <3.5g/dL and well-nourished as albumin >3.5g/dL. We considered obesity to be a BMI >30kg/m2 and non-obese as BMI <30kg/m2. We created 4 groups - malnourished, obese (MN-Obese); malnourished, non-obese (MN-NonObese); well-nourished, obese (N-Obese); and well-nourished, non-obese (N-NonObese). We compared time to first HF exacerbation post-LVAD implantation amongst the 4 groups.Results745 patients were included for analysis: 25% (n=185) MN-Obese, 45% (340) MN-NonObese, 14% (105) N-Obese and 16% (117) N-NonObese. Independent of nutritional status, obese patients were more likely to self-report as Black (p = 0.021), and have diabetes, hypertension and OSA (p = < 0.001 for all). Obese patients had higher incidence of first HF exacerbation than non-obese patients regardless of nutritional status (Figure). At 1 year, 20% of MN-NonObese and 13% of N-NonObese patients had been hospitalized compared to 32% of MN-Obese and 37% of N-Obese patients (p < 0.001). One year survival was similar between the groups.ConclusionAlthough there was no association with survival, obese LVAD patients have a higher rate of heart failure hospitalizations than non-obese. Malnutrition appears to increase the rate of hospitalization in non-obese LVAD patients, but not in the obese. Further investigation is warranted to understand the impact of BMI and nutritional status on long-term clinical outcomes with LVAD therapy. Malnutrition and cardiac cachexia with low body mass index (BMI) are recognized pre-implant risk factors for adverse post-LVAD outcomes. The obesity paradox has defined a protective effect of higher BMI in terms of outcomes in heart failure (HF) patients. We evaluated the interaction of nutritional state (estimated by albumin) with BMI on LVAD outcomes. A retrospective cohort study of patients implanted with continuous flow LVAD at our center between 2006 and 2022 was performed. Patients were stratified into four quartiles based on nutritional status and BMI. We considered malnourished to be albumin <3.5g/dL and well-nourished as albumin >3.5g/dL. We considered obesity to be a BMI >30kg/m2 and non-obese as BMI <30kg/m2. We created 4 groups - malnourished, obese (MN-Obese); malnourished, non-obese (MN-NonObese); well-nourished, obese (N-Obese); and well-nourished, non-obese (N-NonObese). We compared time to first HF exacerbation post-LVAD implantation amongst the 4 groups. 745 patients were included for analysis: 25% (n=185) MN-Obese, 45% (340) MN-NonObese, 14% (105) N-Obese and 16% (117) N-NonObese. Independent of nutritional status, obese patients were more likely to self-report as Black (p = 0.021), and have diabetes, hypertension and OSA (p = < 0.001 for all). Obese patients had higher incidence of first HF exacerbation than non-obese patients regardless of nutritional status (Figure). At 1 year, 20% of MN-NonObese and 13% of N-NonObese patients had been hospitalized compared to 32% of MN-Obese and 37% of N-Obese patients (p < 0.001). One year survival was similar between the groups. Although there was no association with survival, obese LVAD patients have a higher rate of heart failure hospitalizations than non-obese. Malnutrition appears to increase the rate of hospitalization in non-obese LVAD patients, but not in the obese. Further investigation is warranted to understand the impact of BMI and nutritional status on long-term clinical outcomes with LVAD therapy.