Original Articles
28 June 2024
Vol. 2 No. 2 (2024)
https://doi.org/10.4081/cardio.2024.38

Treatment pathways in patients with heart failure with preserved ejection fraction and obesity: perspectives from cardiology specialists and patients

Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Heart failure, obesity management, surveys and questionnaires, cardiology
1776
Views
1002
Downloads
3
HTML

Authors

Javed Butler
javed.butler@bswhealth.org
Baylor Scott and White Research Institute, Dallas, TX; University of Mississippi Medical Center, Jackson, MS, United States.
Sanjiv J. Shah
Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
Melissa Magwire
Saint Luke's Mid America Heart Institute, Kansas City, MO, United States.
Carlos Campos
Department of Family Medicine, UT Health San Antonio, San Antonio, TX, United States.
Muhammad Shariq Usman
Department of Medicine, UT Southwestern Medical Center, Dallas, TX; Department of Medicine, Parkland Health and Hospital System, Dallas, TX, United States.
Anthony Hoovler
Novo Nordisk Inc., Plainsboro, NJ, United States.
Anup Sabharwal
Novo Nordisk Inc., Plainsboro, NJ, United States.
Barry A. Borlaug
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States.

Background: Obesity, highly prevalent in patients with heart failure with preserved ejection fraction (HFpEF), may make HFpEF more difficult to diagnose by masking its signs. The aim of this study was to identify challenges patients and healthcare professionals (HCPs) face in diagnosing and treating patients with HFpEF and obesity.
Methods: An anonymous, US populationbased online survey was conducted in September 2020 among 114 patients with obesity and a selfreported diagnosis of HFpEF and 200 HCPs.
Results: In the typical medical journey, almost half of patients (45%) were diagnosed with HFpEF within one month of discussing symptoms with an HCP; however, the remaining patients waited an average of 22 months for diagnosis, most of whom (78%) received their diagnosis from a cardiologist. Most patients (65%) perceived their cardiologist as the coordinator of their HFpEF care. The treatments most recommended by cardiologists for the ongoing treatment of HFpEF included lifestyle changes (91%), diuretics (87%), beta blockers (76%), and angiotensinconverting enzyme inhibitors (71%). Heart failure specialists (29%) were more likely than general cardiology specialists (12%) to report recommending prescription weightloss medications for management of HFpEF. Most cardiologists reported not having received formal training in obesity management.
Conclusions: Cardiology specialists play a central role in the diagnosis and management of HFpEF, but optimal coordination is needed to improve obesity management in patients with HFpEF.

Altmetrics

Downloads

Download data is not yet available.

Citations

Crossref
Scopus
Google Scholar
Europe PMC
Afshin A, Forouzanfar MH, Reitsma MB, et al. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med 2017;377:13-27. DOI: https://doi.org/10.1056/NEJMoa1614362
Kelly T, Yang W, Chen CS, Reynolds K, He J. Global burden of obesity in 2005 and projections to 2030. Int J Obes (Lond) 2008;32:1431-7. DOI: https://doi.org/10.1038/ijo.2008.102
Kenchaiah S, Evans JC, Levy D, et al. Obesity and the risk of heart failure. N Engl J Med 2002;347:305-13. DOI: https://doi.org/10.1056/NEJMoa020245
Dunlay SM, Roger VL, Redfield MM. Epidemiology of heart failure with preserved ejection fraction. Nat Rev Cardiol 2017;14:591-602. DOI: https://doi.org/10.1038/nrcardio.2017.65
Roth GA, Mensah GA, Johnson CO, et al. Global burden of cardiovascular diseases and risk factors, 1990-2019: update from the GBD 2019 study. J Am Coll Cardiol 2020;76:2982-3021. DOI: https://doi.org/10.1016/j.jacc.2020.11.010
Obokata M, Reddy YNV, Pislaru SV, Melenovsky V, Borlaug BA. Evidence supporting the existence of a distinct obese phenotype of heart failure with preserved ejection fraction. Circulation 2017;136:6-19. DOI: https://doi.org/10.1161/CIRCULATIONAHA.116.026807
Kitzman DW, Lam CSP. Obese heart failure with preserved ejection fraction phenotype. Circulation 2017;136:20-3. DOI: https://doi.org/10.1161/CIRCULATIONAHA.117.028365
Reddy YNV, Lewis GD, Shah SJ, et al. Characterization of the obese phenotype of heart failure with preserved ejection fraction: a RELAX trial ancillary study. Mayo Clin Proc 2019;94:1199-209. DOI: https://doi.org/10.1016/j.mayocp.2018.11.037
Obokata M, Reddy YNV, Melenovsky V, Sorimachi H, Jarolim P, Borlaug BA. Uncoupling between intravascular and distending pressures leads to underestimation of circulatory congestion in obesity. Eur J Heart Fail 2022;24:353-61. DOI: https://doi.org/10.1002/ejhf.2377
Reddy YNV, Rikhi A, Obokata M, et al. Quality of life in heart failure with preserved ejection fraction: importance of obesity, functional capacity, and physical inactivity. Eur J Heart Fail 2020;22:1009-18. DOI: https://doi.org/10.1002/ejhf.1788
Adamson C, Kondo T, Jhund PS, et al. Dapagliflozin for heart failure according to body mass index: the DELIVER trial. Eur Heart J 2022;43:4406-17. DOI: https://doi.org/10.1093/eurheartj/ehac481
Kitzman DW, Brubaker P, Morgan T, et al. Effect of caloric restriction or aerobic exercise training on peak oxygen consumption and quality of life in obese older patients with heart failure with preserved ejection fraction: a randomized clinical Trial. JAMA 2016;315:36-46. DOI: https://doi.org/10.1001/jama.2015.17346
Sorimachi H, Obokata M, Omote K, et al. Long-term changes in cardiac structure and function following bariatric surgery. J Am Coll Cardiol 2022;80:1501-12. DOI: https://doi.org/10.1016/j.jacc.2022.08.738
Reddy YNV, Anantha-Narayanan M, Obokata M, et al. Hemodynamic effects of weight loss in obesity: a systematic review and meta-analysis. JACC Heart Fail 2019;7:678-87. DOI: https://doi.org/10.1016/j.jchf.2019.04.019
Verbrugge FH, Omote K, Reddy YNV, Sorimachi H, Obokata M, Borlaug BA. Heart failure with preserved ejection fraction in patients with normal natriuretic peptide levels is associated with increased morbidity and mortality. Eur Heart J 2022;43:1941-51. DOI: https://doi.org/10.1093/eurheartj/ehab911
van Veldhuisen DJMDP, Linssen GCMMDP, Jaarsma TRNP, et al. B-type natriuretic peptide and prognosis in heart failure patients with preserved and reduced ejection fraction. J Am Coll Cardiol 2013;61:1498-506. DOI: https://doi.org/10.1016/j.jacc.2012.12.044
Mueller C, McDonald K, de Boer RA, et al. Heart failure association of the European Society of Cardiology practical guidance on the use of natriuretic peptide concentrations. Eur J Heart Fail 2019;21:715-31. DOI: https://doi.org/10.1002/ejhf.1494
Wang TJ, Larson MG, Levy D, et al. Impact of obesity on plasma natriuretic peptide levels. Circulation 2004;109:594-600. DOI: https://doi.org/10.1161/01.CIR.0000112582.16683.EA
Khan SS, Huffman MD, Shah SJ. Could a low-dose diuretic polypill improve outcomes in heart failure with preserved ejection fraction? Circulation 2021;14:e008090. DOI: https://doi.org/10.1161/CIRCHEARTFAILURE.120.008090
Anker SD, Butler J, Filippatos G, et al. Empagliflozin in heart failure with a preserved ejection fraction. New Engl J Med 2021;385:1451-61. DOI: https://doi.org/10.1056/NEJMoa2107038
Solomon SD, McMurray JJV, Claggett B, et al. Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med 2022;387:1089-98. DOI: https://doi.org/10.1056/NEJMoa2206286
Bhatt DL, Szarek M, Steg PG, et al. Sotagliflozin in patients with diabetes and recent worsening heart failure. New Engl J Med 2020;384:117-28. DOI: https://doi.org/10.1056/NEJMoa2030183
Gallgher A. FDA approves expanded label for dapagliflozin to reduce risk of cardiovascular death, hospitalization from heart failure. Pharmacy Times, May 9, 2023. Available from: https://www.pharmacytimes.com/view/fda-approves-expanded-label-for-dapagliflozin-to-reduce-risk-of-cardiovascular-death-hospitalization-from-heart-failure (accessed June 14, 2023).
Sorimachi H, Obokata M, Takahashi N, et al. Pathophysiologic importance of visceral adipose tissue in women with heart failure and preserved ejection fraction. Eur Heart J 2021;42:1595-605. DOI: https://doi.org/10.1093/eurheartj/ehaa823
Sorimachi H, Burkhoff D, Verbrugge FH, et al. Obesity, venous capacitance, and venous compliance in heart failure with preserved ejection fraction. Eur J Heart Fail 2021;23:1648-58. DOI: https://doi.org/10.1002/ejhf.2254
Sorimachi H, Omote K, Omar M, et al. Sex and central obesity in heart failure with preserved ejection fraction. Eur J Heart Fail 2022;24:1359-70. DOI: https://doi.org/10.1002/ejhf.2563
Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure. J Card Fail 2022;28:e1-167 DOI: https://doi.org/10.1016/j.cardfail.2022.02.009
Bramante CT, Raatz S, Bomberg EM, Oberle MM, Ryder JR. Cardiovascular risks and benefits of medications used for weight loss. Front Endocrinol 2019;10:883. DOI: https://doi.org/10.3389/fendo.2019.00883
Kosiborod MN, Abildstrøm SZ, Borlaug BA, et al. Design and baseline characteristics of STEP-HFpEF program evaluating semaglutide in patients with obesity HFpEF phenotype. JACC Heart Fail 2023;11:1000-10. DOI: https://doi.org/10.1016/j.jchf.2023.05.010

How to Cite



1.
Butler J, Shah SJ, Magwire M, Campos C, Usman MS, Hoovler A, et al. Treatment pathways in patients with heart failure with preserved ejection fraction and obesity: perspectives from cardiology specialists and patients. Global Cardiol [Internet]. 2024 Jun. 28 [cited 2025 Aug. 19];2(2). Available from: https://www.globalcardiology.info/site/article/view/38
Copyright (c) 2024 the Author(s) Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.