TY - JOUR T1 - Association of body mass index with outcomes in patients with newly diagnosed atrial fibrillation: GARFIELD-AF JF - Open Heart JO - Open Heart DO - 10.1136/openhrt-2022-002038 VL - 9 IS - 2 SP - e002038 AU - Christian Fielder Camm AU - Saverio Virdone AU - Shinya Goto AU - Jean-Pierre Bassand AU - Martin van Eickels AU - Sylvia Haas AU - Bernard J Gersh AU - Karen Pieper AU - Keith A A Fox AU - Frank Misselwitz AU - Alexander G G Turpie AU - Samuel Z Goldhaber AU - Freek Verheugt AU - John Camm AU - Gloria Kayani AU - Elizaveta Panchenko AU - Seil Oh AU - Hector Lucas Luciardi AU - Jitendra Pal Singh Sawhney AU - Stuart J Connolly AU - Pantep Angchaisuksiri AU - Hugo ten Cate AU - John W Eikelboom AU - Ajay K Kakkar A2 - , Y1 - 2022/08/01 UR - http://openheart.bmj.com/content/9/2/e002038.abstract N2 - Objective While greater body mass index (BMI) is associated with increased risk of developing atrial fibrillation (AF), the impact of BMI on outcomes in newly diagnosed AF is unclear. We examine the influence of BMI on outcomes and whether this is modified by sex and evaluate the effect of non-vitamin K oral anticoagulants (NOACs) in patients with high BMI.Methods GARFIELD-AF is a prospective registry of 52 057 newly diagnosed AF patients. The study population comprised 40 482 participants: 703 underweight (BMI <18.5 kg/m2), 13 095 normal (BMI=18.5–24.9 kg/m2), 15 043 overweight (BMI=25.0–29.9 kg/m2), 7560 obese (BMI=30.0–34.9 kg/m2) and 4081 extremely obese (BMI ≥35.0 kg/m2). Restricted cubic splines quantified the association of BMI with outcomes. Comparative effectiveness of NOACs and vitamin K antagonists (VKAs) by BMI was performed using propensity score overlap-weighted Cox models.Results The median age of participants was 71.0 years (Q1; Q3 62.0; 78.0), and 55.6% were male. Those with high BMI were younger, more often had vascular disease, hypertension and diabetes. Within 2-year follow-up, a U-shaped relationship between BMI and all-cause mortality was observed, with BMI of ~30 kg/m2 associated with the lowest risk. The association with new/worsening heart failure was similar. Only low BMI was associated with major bleeding and no association emerged for non-haemorrhagic stroke. BMI was similarly associated with outcomes in men and women. BMI did not impact the lower rate of all-cause mortality of NOACs compared with VKAs.Conclusions In the GARFIELD-AF registry, underweight and extremely obese AF patients have increased risk of mortality and new/worsening heart failure compared with normal or obese patients.All data relevant to the study are included in the article or uploaded as supplementary information. ER -