What is new?
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This multicenter population-based cohort from 150 hospitals distributed throughout almost all regions of China is the largest contemporary registry study that explored BMI–related differences in clinical characteristics, management, and outcomes of patients with atrial fibrillation (AF).
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Patients with BMI > 23 in China required more frequent oral medical treatments and intervention strategies and presented lower in-hospital mortality rate than normal–underweight patients.
What are the clinical implications?
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The quality of care for low–BMI patients hospitalized for AF in China should be improved using evidence-based treatments and strategies for prevention.
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Low BMI patients exhibit poorer in-hospital mortality compared with normal–weight or overweight patients. Thus, improving weight management may aid in reducing the observed weight differences in in-hospital mortality.
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The association between abdominal obesity and fat distribution with AF in China must be further investigated.
Background
Method
Study population
Data collection
Definitions
Statistical analysis
Results
Baseline characteristics
Variables | Total N = 15,867 | Underweight BMI < 18.5 (n = 830) | Normal 18.5 ≤ BMI < 23 (n = 4965) | Overweight 23 ≤ BMI < 25 (n = 3716) | Obese, class I 25 ≤ BMI < 30 (n = 5263) | Obese, class II BMI ≥ 30 (n = 1093) | p value |
---|---|---|---|---|---|---|---|
Age | 68.09 ± 11.93 | 72.42 ± 12.69 | 69.46 ± 12.01 | 68.11 ± 11.65 | 66.62 ± 11.57 | 65.64 ± 11.90 | < 0.001 |
Male | 8860 (55.8) | 352 (42.4) | 2610 (52.6) | 2158 (58.1) | 3189 (60.6) | 551 (50.4) | < 0.001 |
Current smoker | 3421 (21.6) | 147 (17.7) | 990 (19.9) | 764 (20.6) | 1291 (24.5) | 229 (21.0) | < 0.001 |
Current drinking | 1808 (11.4) | 60 (7.2) | 476 (9.6) | 412 (11.1) | 722 (13.7) | 138 (12.6) | < 0.001 |
Comorbidities | |||||||
Hypertension | 8504 (53.6) | 296 (35.7) | 2306 (46.4) | 1954 (52.6) | 3205 (60.9) | 743 (68.0) | < 0.001 |
Diabetes mellitus | 2712 (17.1) | 68 (8.2) | 641 (12.9) | 666 (17.9) | 1064 (20.2) | 273 (25.0) | < 0.001 |
CAD | 3667 (23.1) | 180 (21.7) | 1073 (21.6) | 909 (24.5) | 1236 (23.5) | 269 (24.6) | 0.012 |
CHF | 2194 (13.8) | 171 (20.6) | 747 (15.0) | 500 (13.5) | 642 (12.2) | 134 (12.3) | < 0.001 |
Stroke | 2024 (12.8) | 113 (13.6) | 628 (12.6) | 489 (13.2) | 658 (12.5) | 136 (12.4) | 0.820 |
Renal failure | 396 (2.4) | 39 (4.7) | 129 (2.6) | 81 (2.2) | 130 (2.5) | 17 (1.6) | < 0.001 |
Underwent dialysis | 22 (5.5) | 2 (5.1) | 10 (7.8) | 3 (3.7) | 6 (4.6) | 1 (5.9) | 0.002 |
Renal transplant | 7 (1.8) | 0 (0) | 3 (2.3) | 0 (0) | 4 (3.1) | 0 (0) | 0.001 |
Rheumatic heart disease | 887 (5.6) | 105 (12.7) | 386 (7.8) | 198 (5.3) | 169 (3.2) | 29 (2.7) | < 0.001 |
COPD | 613 (3.9) | 57 (6.9) | 202 (4.1) | 132 (3.6) | 179 (3.4) | 43 (3.9) | < 0.001 |
Cancer | 260 (1.6) | 27 (3.3) | 105 (2.1) | 61 (1.6) | 55 (1.0) | 12 (1.1) | < 0.001 |
First diagnosis of AF | 1609 (10.1) | 84 (10.1) | 482 (9.7) | 403 (10.8) | 545 (10.4) | 95 (8.7) | < 0.001 |
Non-valvular AF | 13,792 (86.9) | 610 (73.5) | 4106 (82.7) | 3265 (87.9) | 4796 (91.1) | 1015 (92.9) | < 0.001 |
On admission value | |||||||
HR at rest (bmp/min) | 88.64 ± 27.68 | 93.45 ± 29.77 | 88.57 ± 27.90 | 88.05 ± 27.92 | 87.87 ± 26.85 | 91.03 ± 27.35 | < 0.001 |
SBP (mmHg) | 130.57 ± 20.45 | 123.69 ± 21.04 | 128.50 ± 20.57 | 130.50 ± 20.47 | 132.64 ± 19.85 | 135.45 ± 19.81 | < 0.001 |
DBP (mmHg) | 78.82 ± 13.33 | 74.11 ± 13.52 | 77.10 ± 13.12 | 78.69 ± 13.15 | 80.46 ± 13.21 | 82.74 ± 13.20 | < 0.001 |
QTc (ms) | 419.22 ± 64.13 | 416.15 ± 60.39 | 418.82 ± 65.16 | 417.48 ± 61.78 | 419.31 ± 62.92 | 428.15 ± 59.31 | 0.003 |
LVEDd (ms) | 49.99 ± 8.18 | 48.26 ± 9.41 | 49.75 ± 8.71 | 49.82 ± 8.02 | 50.36 ± 7.74 | 51.00 ± 7.18 | < 0.001 |
LAAP (mm) | 42.73 ± 9.11 | 43.42 ± 11.75 | 42.39 ± 9.46 | 42.11 ± 9.21 | 43.02 ± 8.33 | 44.28 ± 8.46 | < 0.001 |
LVEF | < 0.001 | ||||||
< 40% | 1151 (7.3) | 77 (9.3) | 421 (8.5) | 241 (6.5) | 338 (6.4) | 74 (6.8) | – |
40–49% | 1463 (9.2) | 95 (11.4) | 468 (9.4) | 354 (9.5) | 450 (8.6) | 96 (8.8) | – |
≥ 50% | 13,253 (83.5) | 658 (79.3) | 4076 (82.1) | 3121 (84.0) | 4475 (85.0) | 923 (84.4) | – |
CHADS2score | 0.001 | ||||||
0–1 | 9541 (60.1) | 489 (58.9) | 3058 (61.6) | 2265 (61.0) | 3126 (59.4) | 603 (55.2) | – |
2 | 3519 (22.2) | 196 (23.6) | 1088 (21.9) | 773 (20.8) | 1179 (22.4) | 283 (25.9) | – |
3–6 | 2782 (17.5) | 141 (17.0) | 809 (16.3) | 670 (18.0) | 955 (18.1) | 207 (18.9) | – |
CHA2DS2-VAS score | < 0.001 | ||||||
0–1 | 4646 (29.3) | 184 (22.2) | 1396 (28.1) | 1101 (29.6) | 1674 (31.8) | 291 (26.6) | – |
2–4 | 9082 (57.2) | 519 (62.5) | 2937 (59.2) | 2107 (56.7) | 2881 (54.7) | 638 (58.4) | – |
5–9 | 2114 (13.3) | 123 (14.8) | 622 (12.5) | 500 (13.5) | 705 (13.4) | 164 (15.0) | – |
Medication history | |||||||
Beta-blocker | 4485 (28.3) | 190 (22.9) | 1289 (26.0) | 1002 (27.0) | 1633 (31.0) | 371 (33.9) | < 0.001 |
CCB | 2361 (14.9) | 76 (9.2) | 601 (12.1) | 500 (13.5) | 982 (18.7) | 202 (18.5) | < 0.001 |
Antiarrhythmic agents | 1404 (8.8) | 35 (4.2) | 378 (7.6) | 329 (8.9) | 540 (10.3) | 122 (11.2) | < 0.001 |
Antiplatelet agents | 1137 (7.2) | 48 (5.8) | 351 (7.1) | 286 (7.7) | 359 (6.8) | 93 (8.5) | 0.094 |
Warfarin | 2097 (13.2) | 118 (14.2) | 653 (13.2) | 509 (13.7) | 668 (12.7) | 149 (13.6) | 0.127 |
Aspirin | 3302 (20.8) | 114 (13.7) | 952 (19.2) | 786 (21.2) | 1185 (22.5) | 265 (24.2) | < 0.001 |
Management during hospitalization and discharge
In-hospital outcomes
Variables | Total N = 15,867 | Underweight BMI < 18.5 (n = 830) | Normal 18.5 ≤ BMI < 23 (n = 4965) | Overweight 23 ≤ BMI < 25 (n = 3716) | Obese, class I 25 ≤ BMI < 30 (n = 5263) | Obese, class II BMI ≥ 30 (n = 1093) | p value |
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HR at rest (bmp/min) | 76.24 ± 17.50 | 77.96 ± 20.04 | 76.69 ± 17.89 | 75.00 ± 16.47 | 76.26 ± 17.42 | 77.27 ± 17.46 | 0.002 |
Length of stay, days | 9.17 ± 8.77 | 9.83 ± 6.96 | 9.27 ± 7.36 | 9.28 ± 12.21 | 8.98 ± 7.73 | 8.76 ± 6.13 | 0.031 |
Guidance on quitting smoking | 3120 (19.7) | 142 (17.1) | 921 (18.5) | 705 (19.0) | 1147 (21.8) | 205 (18.8) | < 0.001 |
Guidance on dietary patterns | 14,157 (89.2) | 741 (89.3) | 4423 (89.1) | 3304 (88.9) | 4712 (89.5) | 977 (89.4) | 0.007 |
Weight management | 11,032 (69.5) | 497 (59.9) | 3306 (66.6) | 2583 (69.5) | 3801 (72.2) | 845 (77.3) | < 0.001 |