RT Journal Article
SR Electronic
T1 Association of body mass index with outcomes in patients with newly diagnosed atrial fibrillation: GARFIELD-AF
JF Open Heart
JO Open Heart
FD British Cardiovascular Society
SP e002038
DO 10.1136/openhrt-2022-002038
VO 9
IS 2
A1 Christian Fielder Camm
A1 Saverio Virdone
A1 Shinya Goto
A1 Jean-Pierre Bassand
A1 Martin van Eickels
A1 Sylvia Haas
A1 Bernard J Gersh
A1 Karen Pieper
A1 Keith A A Fox
A1 Frank Misselwitz
A1 Alexander G G Turpie
A1 Samuel Z Goldhaber
A1 Freek Verheugt
A1 John Camm
A1 Gloria Kayani
A1 Elizaveta Panchenko
A1 Seil Oh
A1 Hector Lucas Luciardi
A1 Jitendra Pal Singh Sawhney
A1 Stuart J Connolly
A1 Pantep Angchaisuksiri
A1 Hugo ten Cate
A1 John W Eikelboom
A1 Ajay K Kakkar
A1 ,
YR 2022
UL http://openheart.bmj.com/content/9/2/e002038.abstract
AB 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.