Introduction
Methods
Search strategy, study selection
Statistical analysis
Results
Baseline characteristics
All (n = 5819) | BMI < 18.5 (n = 83) | BMI 18.5–25 (n = 2062) | BMI 25–30 (n = 2503) | BMI ≥ 30 (n = 1171) | p | |
---|---|---|---|---|---|---|
Age (years) | 64.9 ± 11.5 | 69.1 ± 14.1 | 67.1 ± 11.7 | 64.8 ± 10.6 | 61.0 ± 11.6 | < 0.001 |
Age ≥ 75 years | 1053 (18.1%) | 30 (36.1%) | 517 (25.1%) | 384 (15.3%) | 122 (10.4%) | < 0.001 |
Male gender | 4561 (78.4%) | 36 (43.4%) | 1563 (75.8%) | 2067 (82.6%) | 895 (76.4%) | < 0.001 |
Ischaemic aetiology | 3256 (56.0%) | 39 (47.0%) | 1182 (57.3%) | 1454 (58.1%) | 581 (49.6%) | < 0.001 |
Hypertension | 2776 (47.7%) | 37 (44.6%) | 841 (40.8%) | 1231 (49.2%) | 667 (57.0%) | < 0.001 |
Cancer | 427 (7.3%) | 8 (9.6%) | 177 (8.6%) | 167 (6.7%) | 75 (6.4%) | 0.04 |
COPD | 860 (14.8%) | 24 (28.9%) | 295 (14.3%) | 345 (13.8%) | 196 (16.7%) | < 0.001 |
Diabetes | 1563 (26.9%) | 9 (10.8%) | 446 (21.6%) | 682 (27.2%) | 426 (36.4%) | < 0.001 |
Haemoglobin (g/dl) | 13.6 ± 1.5 | 12.8 ± 1.7 | 13.4 ± 1.5 | 13.7 ± 1.5 | 13.7 ± 1.5 | < 0.001 |
Anaemia | 1605 (27.6%) | 32 (38.6%) | 665 (32.3%) | 634 (25.3%) | 274 (23.4%) | < 0.001 |
eGFR | 58.8 ± 17.2 | 58.5 ± 26.1 | 57.9 ± 17.6 | 58.5 ± 16.2 | 61.1 ± 17.7 | < 0.001 |
eGFR < 45 | 1192 (20.5%) | 30 (36.1%) | 481 (23.3%) | 489 (19.5%) | 192 (16.4%) | < 0.001 |
Atrial fibrillation | 893 (15.4%) | 10 (12.0%) | 305 (14.8%) | 382 (15.3%) | 196 (16.7%) | 0.41 |
LVEF | 28.9 ± 9.1 | 27.9 ± 10.6 | 28.3 ± 8.9 | 29.1 ± 8.6 | 29.8 ± 9.9 | < 0.001 |
LVEF ≤ 40% | 5527 (95.0%) | 75 (90.4%) | 1969 (95.5%) | 2390 (95.5%) | 1093 (93.3%) | 0.004 |
NYHA III/IV | 2282 (39.2%) | 46 (55.4%) | 879 (42.6%) | 903 (36.1%) | 454 (38.8%) | < 0.001 |
ACE/ARB | 5242 (90.1%) | 69 (83.1%) | 1848 (89.6%) | 2251 (90.0%) | 1071 (91.7%) | 0.04 |
β-Blocker | 2706 (46.5%) | 31 (37.3%) | 921 (44.7%) | 1192 (47.6%) | 562 (48.0%) | 0.05 |
MRA | 954 (16.4%) | 19 (22.9%) | 359 (17.4%) | 402 (16.1%) | 174 (14.9%) | 0.10 |
NT-proBNP (pg/ml) | 1001 [416, 2345] | 2587 [980, 5364] | 1509 [613, 3303] | 912 [392, 2020] | 653 [277, 1409] | < 0.001 |
hs-cTnT (pg/ml) | 14.8 [7.5, 26.3] | 16.9 [9.4, 29.1] | 15.9 [7.8, 29.5] | 14.2 [7.4, 24.9] | 14.7 [7.7, 24.0] | 0.001 |
sST2 (ng/ml) | 26.9 [20.2, 38.5] | 31.2 [22.3, 39.3] | 28.5 [20.6, 42.4] | 26.8 [20.2, 37.4] | 25.4 [19.3, 34.2] | < 0.001 |
Survival analysis
Multivariable predictors of outcome
Overall survival | Survival free of HF hospitalization | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
HR | 95% CI | Wald | p | HR | 95% CI | Wald | p | |||
A: No co-morbidities and age < 75 years | ||||||||||
BMI categories | 3.4 | 0.39 | 2.4 | 0.49 | ||||||
≤ 18.5 kg/m2 | 0.954 | 0.232 | 3.922 | 0.0 | 0.95 | 0.883 | 0.325 | 2.398 | 0.1 | 0.81 |
18.5–25.0 kg/m2 | 1.140 | 0.815 | 1.595 | 0.6 | 0.45 | 1.060 | 0.840 | 1.337 | 0.2 | 0.63 |
25.0–30.0 kg/m2 | 0.887 | 0.638 | 1.232 | 0.5 | 0.47 | 0.917 | 0.732 | 1.147 | 0.6 | 0.45 |
> 30.0 kg/m2 | 1 | Ref | 1 | Ref | ||||||
Age | – | – | – | – | – | 1.010 | 1.001 | 1.019 | 5.1 | 0.02 |
eGFR | 0.985 | 0.976 | 0.995 | 8.8 | 0.003 | – | – | – | – | – |
Ischaemic aetiology | 1.562 | 1.219 | 2.002 | 12.1 | < 0.001 | 1.267 | 1.069 | 1.501 | 7.4 | 0.004 |
NYHA III/IV | 1.715 | 1.335 | 2.203 | 18.5 | < 0.001 | 1.564 | 1.311 | 1.867 | 24.6 | < 0.001 |
LVEF | 0.960 | 0.944 | 0.976 | 25.0 | < 0.001 | 0.975 | 0.965 | 0.986 | 20.0 | < 0.001 |
Atrial fibrillation | – | – | – | – | – | 1.389 | 1.104 | 1.748 | 7.9 | 0.005 |
B: At least one co-morbidity or age > 75 years | ||||||||||
BMI categories | 22.4 | < 0.001 | 10.3 | 0.02 | ||||||
≤ 18.5 kg/m2 | 2.037 | 1.366 | 3.039 | 12.2 | < 0.001 | 1.320 | 0.927 | 1.880 | 2.4 | 0.12 |
18.5–25.0 kg/m2 | 1.214 | 1.009 | 1.461 | 4.2 | 0.04 | 1.115 | 0.969 | 1.285 | 2.3 | 0.13 |
25.0–30.0 kg/m2 | 0.963 | 0.802 | 1.156 | 0.2 | 0.69 | 0.951 | 0.829 | 1.090 | 0.5 | 0.47 |
> 30.0 kg/m2 | 1 | Ref | 1 | Ref | ||||||
Haemoglobin | 0.911 | 0.874 | 0.949 | 20.1 | < 0.001 | 0.911 | 0.882 | 0.941 | 31.9 | < 0.001 |
Age | 1.021 | 1.014 | 1.028 | 31.4 | < 0.001 | 1.012 | 1.007 | 1.018 | 18.7 | < 0.001 |
Cancer | 1.223 | 1.016 | 1.473 | 4.5 | 0.03 | – | – | – | – | – |
COPD | 1.266 | 1.098 | 1.459 | 10.6 | 0.001 | 1.374 | 1.228 | 1.538 | 30.8 | < 0.001 |
eGFR | 0.987 | 0.983 | 0.991 | 39.4 | < 0.001 | 0.990 | 0.987 | 0.994 | 36.9 | < 0.001 |
Ischaemic aetiology | 1.232 | 1.080 | 1.406 | 9.6 | 0.002 | 1.158 | 1.045 | 1.283 | 7.9 | 0.005 |
Diabetes | 1.194 | 1.050 | 1.357 | 7.3 | 0.007 | 1.318 | 1.192 | 1.457 | 29.1 | < 0.001 |
Female gender | 0.652 | 0.556 | 0.766 | 27.3 | < 0.001 | 0.788 | 0.697 | 0.891 | 14.6 | < 0.001 |
NYHA III/IV | 1.527 | 1.347 | 1.731 | 43.7 | < 0.001 | 1.340 | 1.215 | 1.478 | 34.4 | < 0.001 |
Atrial fibrillation | 1.206 | 1.035 | 1.404 | 5.8 | 0.02 | 1.250 | 1.106 | 1.413 | 12.7 | < 0.001 |
LVEF | 0.984 | 0.978 | 0.991 | 20.4 | < 0.001 | 0.995 | 0.990 | 1.000 | 3.5 | 0.06 |
Overall survival | Survival free of HF hospitalization | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
HR | 95%-CI | Wald | p | HR | 95% CI | Wald | p | |||
A: No co-morbidities and age < 75 years | ||||||||||
BMI | 1.9 | 0.60 | 1.9 | 0.55 | ||||||
≤ 18.5 kg/m2 | 0.821 | 0.198 | 3.408 | 0.1 | 0.79 | 0.881 | 0.323 | 2.402 | 0.1 | 0.81 |
18.5–25.0 kg/m2 | 1.025 | 0.727 | 1.446 | 0.0 | 0.89 | 1.047 | 0.826 | 1.329 | 0.1 | 0.70 |
25.0–30.0 kg/m2 | 0.860 | 0.618 | 1.197 | 0.8 | 0.37 | 0.921 | 0.735 | 1.154 | 0.5 | 0.47 |
> 30.0 kg/m2 | 1 | Ref | 1 | Ref | ||||||
Age | 0.991 | 0.981 | 1.000 | 3.9 | 0.05 | |||||
Ischaemic aetiology | 1.724 | 1.348 | 2.205 | 18.8 | < 0.001 | 1.357 | 1.146 | 1.608 | 12.5 | < 0.001 |
NYHA III/IV | 1.398 | 1.080 | 1.811 | 6.5 | 0.01 | 1.290 | 1.076 | 1.547 | 7.6 | 0.006 |
LVEF | 0.972 | 0.956 | 0.988 | 11.4 | 0.001 | 0.987 | 0.976 | 0.998 | 5.4 | 0.02 |
Log NT-proBNP | 1.772 | 1.307 | 2.403 | 13.6 | < 0.001 | 1.653 | 1.344 | 2.033 | 22.7 | < 0.001 |
Log hs-cTnT | 2.505 | 1.764 | 3.559 | 26.3 | < 0.001 | 2.730 | 2.150 | 3.467 | 67.8 | < 0.001 |
RAS-blocker | – | – | – | – | – | 0.591 | 0.457 | 0.765 | 16.0 | < 0.001 |
β-Blocker | 0.753 | 0.586 | 0.967 | 4.9 | 0.03 | – | – | – | – | – |
B: At least one co-morbidity or age > 75 years | ||||||||||
BMI | 10.7 | 0.01 | 2.3 | 0.51 | ||||||
≤ 18.5 kg/m2 | 1.661 | 1.113 | 2.478 | 6.2 | 0.01 | 1.117 | 0.782 | 1.596 | 0.4 | 0.58 |
18.5–25.0 kg/m2 | 1.004 | 0.835 | 1.207 | 0.0 | 0.97 | 0.981 | 0.851 | 1.132 | 0.1 | 0.77 |
25.0–30.0 kg/m2 | 0.903 | 0.752 | 1.083 | 1.2 | 0.27 | 0.927 | 0.808 | 1.063 | 1.2 | 0.27 |
> 30.0 kg/m2 | 1 | Ref | 1 | Ref | ||||||
eGFR | 0.995 | 0.991 | 0.999 | 7.3 | 0.007 | 0.996 | 0.993 | 0.999 | 6.5 | 0.01 |
Diabetes | – | – | – | – | – | 1.175 | 1.062 | 1.300 | 9.8 | 0.002 |
Haemoglobin | – | – | – | – | – | 0.955 | 0.925 | 0.987 | 7.8 | 0.005 |
COPD | – | – | – | – | – | 1.281 | 1.143 | 1.434 | 18.3 | < 0.001 |
Ischaemic aetiology | 1.294 | 1.135 | 1.475 | 14.9 | < 0.001 | 1.164 | 1.051 | 1.288 | 8.6 | 0.003 |
NYHA III/IV | 1.276 | 1.123 | 1.450 | 14.1 | < 0.001 | 1.171 | 1.060 | 1.294 | 9.7 | 0.002 |
Female gender | 0.713 | 0.611 | 0.832 | 18.4 | < 0.001 | 0.872 | 0.771 | 0.986 | 4.8 | 0.03 |
Log NT-proBNP | 2.198 | 1.884 | 2.566 | 99.8 | < 0.001 | 1.516 | 1.348 | 1.704 | 48.6 | < 0.001 |
Log hs-cTnT | 2.056 | 1.730 | 2.442 | 67.3 | < 0.001 | 2.081 | 1.815 | 2.387 | 109.9 | < 0.001 |
RAS-blocker | – | – | – | – | – | 0.861 | 0.747 | 0.992 | 4.3 | 0.04 |