Body Surface Area as a Prognostic Marker in Chronic Heart Failure Patients. Results from the Heart Failure registry of the European Society of Cardiology

Background: The `obesity paradox` is consistently observed in patients with heart failure (HF). We investigated the relationship of body surface area (BSA), commonly used for indexing physiologic parameters, with mortality and hospitalizations in patients with chronic HF.

Methods: Data from the outpatient cohort of the observational, prospective, HF long-term registry of the Heart failure Association of the ESC was analyzed in order to evaluate the prognostic significance of BSA in chronic HF.

Results: A total of 9,104 chronic HF patients (age 64.8±13.4; 71.6% males) were enrolled. Mortality during 1-year follow-up was observed in 718 of 8875 (8.1%) of patients. A progressive, inverse relationship between all-cause mortality and BSA levels was observed; an adjusted hazard ratio (HR) for 1-year mortality was 1.823 (95% CI, 1.398-2.376), p2, and 1.255 (95% CI, 1.000-1.576), p=0.05 for the lowest to the highest quartiles (1.78≤BSA≤2.07 m²), compared with the highest quartile (BSA>2.07 m²). For each increase of 0.1 m² in BSA an adjusted HR of 0.908 (95% CI, 0.870-0.948), p2 and females 2) had significantly higher mortality rates during follow-up (log-rank p<0.0001). However, the stepwise association with mortality was more distinct in males.

Conclusions: The risk for total mortality, but not CV death and HF hospitalizations, was inversely associated with BSA levels in a large cohort of chronic HF patients. BSA may serve as an important prognostic indicator for adverse outcome in HF patients.