Relation of Obesity to Survival After In-Hospital Cardiac Arrest

Previous studies have shown that obesity is paradoxically associated with improved outcomes in many cardiovascular (CV) disease states; however, whether obesity affects survival after in-hospital cardiac arrest (IHCA) has not been well examined. We queried the 2003 to 2011 Nationwide Inpatient Sampl...

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Published in:	The American journal of cardiology Vol. 118; no. 5; pp. 662 - 667
Main Authors:	Gupta, Tanush, Kolte, Dhaval, Mohananey, Divyanshu, Khera, Sahil, Goel, Kashish, Mondal, Pratik, Aronow, Wilbert S., Jain, Diwakar, Cooper, Howard A., Iwai, Sei, Frishman, William H., Bhatt, Deepak L., Fonarow, Gregg C., Panza, Julio A.
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01.09.2016 Elsevier Limited
Subjects:	Body Mass Index Cardiac arrest Cardiac arrhythmia Cardiopulmonary resuscitation Cardiopulmonary Resuscitation - mortality Cardiovascular CPR Female Heart Arrest - etiology Heart Arrest - mortality Heart Arrest - therapy Hospital Mortality Humans Inpatients - statistics & numerical data Male Middle Aged Obesity Obesity - complications Patient Discharge - statistics & numerical data Prevalence Retrospective Studies Risk Factors Studies Survival Rate United States - epidemiology United States > US in-hospital cardiac arrest cardiopulmonary resuscitation obesity
ISSN:	0002-9149, 1879-1913
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Abstract	Previous studies have shown that obesity is paradoxically associated with improved outcomes in many cardiovascular (CV) disease states; however, whether obesity affects survival after in-hospital cardiac arrest (IHCA) has not been well examined. We queried the 2003 to 2011 Nationwide Inpatient Sample databases to identify all patients aged ≥18 years who underwent cardiopulmonary resuscitation for IHCA. Obese patients were identified using the co-morbidity variable for obesity, as defined in Nationwide Inpatient Sample databases. Survival to hospital discharge was compared between obese and nonobese patients using multivariate regression models. Of 836,289 patients with IHCA, 67,216 (8.0%) were obese. Obese patients were younger and more likely to be women compared with nonobese patients. Despite being younger, obese patients had significantly higher prevalence of most CV co-morbidities such as dyslipidemia, coronary artery disease, previous myocardial infarction, heart failure, diabetes mellitus, hypertension, peripheral vascular disease, and chronic renal failure (p <0.001 for all). Obese patients were more likely to have ventricular tachycardia or ventricular fibrillation as the initial cardiac arrest rhythm (22.3% vs 20.9%; p <0.001). After multivariate risk adjustment, obese patients had improved survival to hospital discharge compared with nonobese patients (31.4% vs 24.1%; unadjusted odds ratio 1.44, 95% CI 1.42 to 1.47, p <0.001; adjusted odds ratio 1.15, 95% CI 1.13 to 1.17, p <0.001). Similar results were seen in patients with CV or non-CV conditions as the primary diagnosis and in those with ventricular tachycardia/ventricular fibrillation or pulseless electrical activity/asystole as the cardiac arrest rhythm. In conclusion, this large retrospective analysis of a nationwide cohort of patients with IHCA demonstrated higher risk-adjusted odds of survival in obese patients, consistent with an “obesity paradox.”
AbstractList	Previous studies have shown that obesity is paradoxically associated with improved outcomes in many cardiovascular (CV) disease states; however, whether obesity affects survival after in-hospital cardiac arrest (IHCA) has not been well examined. We queried the 2003 to 2011 Nationwide Inpatient Sample databases to identify all patients aged >=18 years who underwent cardiopulmonary resuscitation for IHCA. Obese patients were identified using the co-morbidity variable for obesity, as defined in Nationwide Inpatient Sample databases. Survival to hospital discharge was compared between obese and nonobese patients using multivariate regression models. Of 836,289 patients with IHCA, 67,216 (8.0%) were obese. Obese patients were younger and more likely to be women compared with nonobese patients. Despite being younger, obese patients had significantly higher prevalence of most CV co-morbidities such as dyslipidemia, coronary artery disease, previous myocardial infarction, heart failure, diabetes mellitus, hypertension, peripheral vascular disease, and chronic renal failure (p <0.001 for all). Obese patients were more likely to have ventricular tachycardia or ventricular fibrillation as the initial cardiac arrest rhythm (22.3% vs 20.9%; p <0.001). After multivariate risk adjustment, obese patients had improved survival to hospital discharge compared with nonobese patients (31.4% vs 24.1%; unadjusted odds ratio 1.44, 95% CI 1.42 to 1.47, p <0.001; adjusted odds ratio 1.15, 95% CI 1.13 to 1.17, p <0.001). Similar results were seen in patients with CV or non-CV conditions as the primary diagnosis and in those with ventricular tachycardia/ventricular fibrillation or pulseless electrical activity/asystole as the cardiac arrest rhythm. In conclusion, this large retrospective analysis of a nationwide cohort of patients with IHCA demonstrated higher risk-adjusted odds of survival in obese patients, consistent with an "obesity paradox." Abstract Prior studies have shown that obesity is paradoxically associated with improved outcomes in many cardiovascular disease states; however, whether obesity affects survival after in-hospital cardiac arrest (IHCA) has not been well examined. We queried the 2003-2011 Nationwide Inpatient Sample databases (NIS) to identify all patients aged ≥18 years who underwent cardiopulmonary resuscitation for IHCA. Obese patients were identified using the comorbidity variable for obesity, as defined in NIS. Survival to hospital discharge was compared between obese and non-obese patients using multivariate regression models. Of 836,289 patients with IHCA, 67,216 (8.0%) were obese. Obese patients were younger and more likely to be women as compared with non-obese patients. Despite being younger, obese patients had significantly higher prevalence of most cardiovascular comorbidities such as dyslipidemia, coronary artery disease, prior myocardial infarction, heart failure, diabetes mellitus, hypertension, peripheral vascular disease, and chronic renal failure (p<0.001 for all). Obese patients were more likely to have ventricular tachycardia or ventricular fibrillation (VT/VF) as the initial cardiac arrest rhythm (22.3% vs 20.9%; p<0.001). After multivariate risk adjustment, obese patients had improved survival to hospital discharge compared with non-obese patients (31.4% vs. 24.1%; unadjusted OR 1.44, 95% CI 1.42-1.47, p<0.001; adjusted OR 1.15, 95% CI 1.13-1.17, p<0.001). Similar results were seen in patients with cardiovascular or non-cardiovascular conditions as the primary diagnosis and in those with VT/VF or pulseless electrical activity/asystole as the cardiac arrest rhythm. In conclusion, this large retrospective analysis of a nationwide cohort of IHCA patients demonstrated higher risk-adjusted odds of survival in obese patients – consistent with an “obesity paradox.” Previous studies have shown that obesity is paradoxically associated with improved outcomes in many cardiovascular (CV) disease states; however, whether obesity affects survival after in-hospital cardiac arrest (IHCA) has not been well examined. We queried the 2003 to 2011 Nationwide Inpatient Sample databases to identify all patients aged greater than or equal to 18 years who underwent cardiopulmonary resuscitation for IHCA. Obese patients were identified using the co-morbidity variable for obesity, as defined in Nationwide Inpatient Sample databases. Survival to hospital discharge was compared between obese and nonobese patients using multivariate regression models. Of 836,289 patients with IHCA, 67,216 (8.0%) were obese. Obese patients were younger and more likely to be women compared with nonobese patients. Despite being younger, obese patients had significantly higher prevalence of most CV co-morbidities such as dyslipidemia, coronary artery disease, previous myocardial infarction, heart failure, diabetes mellitus, hypertension, peripheral vascular disease, and chronic renal failure (p <0.001 for all). Obese patients were more likely to have ventricular tachycardia or ventricular fibrillation as the initial cardiac arrest rhythm (22.3% vs 20.9%; p <0.001). After multivariate risk adjustment, obese patients had improved survival to hospital discharge compared with nonobese patients (31.4% vs 24.1%; unadjusted odds ratio 1.44, 95% CI 1.42 to 1.47, p <0.001; adjusted odds ratio 1.15, 95% CI 1.13 to 1.17, p <0.001). Similar results were seen in patients with CV or non-CV conditions as the primary diagnosis and in those with ventricular tachycardia/ventricular fibrillation or pulseless electrical activity/asystole as the cardiac arrest rhythm. In conclusion, this large retrospective analysis of a nationwide cohort of patients with IHCA demonstrated higher risk-adjusted odds of survival in obese patients, consistent with an "obesity paradox." Previous studies have shown that obesity is paradoxically associated with improved outcomes in many cardiovascular (CV) disease states; however, whether obesity affects survival after in-hospital cardiac arrest (IHCA) has not been well examined. We queried the 2003 to 2011 Nationwide Inpatient Sample databases to identify all patients aged ≥18 years who underwent cardiopulmonary resuscitation for IHCA. Obese patients were identified using the co-morbidity variable for obesity, as defined in Nationwide Inpatient Sample databases. Survival to hospital discharge was compared between obese and nonobese patients using multivariate regression models. Of 836,289 patients with IHCA, 67,216 (8.0%) were obese. Obese patients were younger and more likely to be women compared with nonobese patients. Despite being younger, obese patients had significantly higher prevalence of most CV co-morbidities such as dyslipidemia, coronary artery disease, previous myocardial infarction, heart failure, diabetes mellitus, hypertension, peripheral vascular disease, and chronic renal failure (p <0.001 for all). Obese patients were more likely to have ventricular tachycardia or ventricular fibrillation as the initial cardiac arrest rhythm (22.3% vs 20.9%; p <0.001). After multivariate risk adjustment, obese patients had improved survival to hospital discharge compared with nonobese patients (31.4% vs 24.1%; unadjusted odds ratio 1.44, 95% CI 1.42 to 1.47, p <0.001; adjusted odds ratio 1.15, 95% CI 1.13 to 1.17, p <0.001). Similar results were seen in patients with CV or non-CV conditions as the primary diagnosis and in those with ventricular tachycardia/ventricular fibrillation or pulseless electrical activity/asystole as the cardiac arrest rhythm. In conclusion, this large retrospective analysis of a nationwide cohort of patients with IHCA demonstrated higher risk-adjusted odds of survival in obese patients, consistent with an "obesity paradox." Previous studies have shown that obesity is paradoxically associated with improved outcomes in many cardiovascular (CV) disease states; however, whether obesity affects survival after in-hospital cardiac arrest (IHCA) has not been well examined. We queried the 2003 to 2011 Nationwide Inpatient Sample databases to identify all patients aged ≥18 years who underwent cardiopulmonary resuscitation for IHCA. Obese patients were identified using the co-morbidity variable for obesity, as defined in Nationwide Inpatient Sample databases. Survival to hospital discharge was compared between obese and nonobese patients using multivariate regression models. Of 836,289 patients with IHCA, 67,216 (8.0%) were obese. Obese patients were younger and more likely to be women compared with nonobese patients. Despite being younger, obese patients had significantly higher prevalence of most CV co-morbidities such as dyslipidemia, coronary artery disease, previous myocardial infarction, heart failure, diabetes mellitus, hypertension, peripheral vascular disease, and chronic renal failure (p <0.001 for all). Obese patients were more likely to have ventricular tachycardia or ventricular fibrillation as the initial cardiac arrest rhythm (22.3% vs 20.9%; p <0.001). After multivariate risk adjustment, obese patients had improved survival to hospital discharge compared with nonobese patients (31.4% vs 24.1%; unadjusted odds ratio 1.44, 95% CI 1.42 to 1.47, p <0.001; adjusted odds ratio 1.15, 95% CI 1.13 to 1.17, p <0.001). Similar results were seen in patients with CV or non-CV conditions as the primary diagnosis and in those with ventricular tachycardia/ventricular fibrillation or pulseless electrical activity/asystole as the cardiac arrest rhythm. In conclusion, this large retrospective analysis of a nationwide cohort of patients with IHCA demonstrated higher risk-adjusted odds of survival in obese patients, consistent with an “obesity paradox.”
Author	Panza, Julio A. Kolte, Dhaval Gupta, Tanush Goel, Kashish Aronow, Wilbert S. Fonarow, Gregg C. Khera, Sahil Cooper, Howard A. Mondal, Pratik Iwai, Sei Frishman, William H. Mohananey, Divyanshu Jain, Diwakar Bhatt, Deepak L.
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Copyright	2016 Elsevier Inc. Elsevier Inc. Copyright © 2016 Elsevier Inc. All rights reserved. Copyright Elsevier Limited Sep 1, 2016
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Snippet	Previous studies have shown that obesity is paradoxically associated with improved outcomes in many cardiovascular (CV) disease states; however, whether... Abstract Prior studies have shown that obesity is paradoxically associated with improved outcomes in many cardiovascular disease states; however, whether...
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SubjectTerms	Body Mass Index Cardiac arrest Cardiac arrhythmia Cardiopulmonary resuscitation Cardiopulmonary Resuscitation - mortality Cardiovascular CPR Female Heart Arrest - etiology Heart Arrest - mortality Heart Arrest - therapy Hospital Mortality Humans Inpatients - statistics & numerical data Male Middle Aged Obesity Obesity - complications Patient Discharge - statistics & numerical data Prevalence Retrospective Studies Risk Factors Studies Survival Rate United States - epidemiology
Title	Relation of Obesity to Survival After In-Hospital Cardiac Arrest
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