BACKGROUND: Obesity is clearly associated with increased morbidity and mortality rates. However, in patients with acute heart failure (AHF), an increased BMI could represent a protective marker. Studies evaluating the "obesity paradox" on a large cohort with long-term follow-up are lacking. METHODS: Using the AHEAD database (a Czech multi-centre database of patients hospitalised due to AHF), 5057 patients were evaluated; patients with a BMI <18.5 kg/m2 were excluded. All-cause mortality was compared between groups with a BMI of 18.5-25 kg/m2 and with BMI >25 kg/m2. Data were adjusted by a propensity score for 11 parameters. RESULTS: In the balanced groups, the difference in 30-day mortality was not significant. The long-term mortality of patients with normal weight was higher than for those who were overweight/obese (HR, 1.36; 95% CI, 1.26-1.48; p<0.001)). In the balanced dataset, the pattern was similar (1.22; 1.09-1.39; p<0.001). A similar result was found in the balanced dataset of a subgroup of patients with de novo AHF (1.30; 1.11-1.52; p = 0.001), but only a trend in a balanced dataset of patients with acute decompensated heart failure. CONCLUSION: These data suggest significantly lower long-term mortality in overweight/obese patients with AHF. The results suggest that at present there is no evidence for weight reduction in overweight/obese patients with heart failure, and emphasize the importance of prevention of cardiac cachexia.

1st Department of Cardiovascular Internal Medicine University Hospital St Anne's Brno Czech Republic

2nd Department of Cardiovascular Internal Medicine 1st Medical Faculty Charles University Prague and General Teaching Hospital of Prague Prague Czech Republic

Department of Cardiology Institute of Clinical and Experimental Medicine Prague Czech Republic

Department of Cardiology Na Homolce Hospital Prague Czech Republic

Department of Cardiology T Bata Hospital Zlin Zlin Czech Republic

Department of Cardiology University Hospital Brno Brno Czech Republic; Department of Cardiovascular Disease International Clinical Research Center University Hospital St Anne's Brno Czech Republic

Department of Cardiology University Hospital Brno Brno Czech Republic; Medical Faculty Masaryk University Brno Czech Republic; Department of Cardiovascular Disease International Clinical Research Center University Hospital St Anne's Brno Czech Republic

Department of Internal Medicine Hospital Frydek Mistek Frydek Mistek Czech Republic

Department of Internal Medicine Hospital Havlickuv Brod Havlickuv Brod Czech Republic

Department of Internal Medicine Hospital Znojmo Znojmo Czech Republic

Department of Internal Medicine University Hospital Olomouc Olomouc Czech Republic

Institute of Biostatistics and Analysis Faculty of Medicine Masaryk University Brno Czech Republic

Kralovske Vinohrady University Hospital and the 3rd Faculty of Medicine Charles University Prague Czech Republic

Medical Faculty Masaryk University Brno Czech Republic; 1st Department of Cardiovascular Internal Medicine University Hospital St Anne's Brno Czech Republic

Medical Faculty Masaryk University Brno Czech Republic; 2nd Department of Internal Medicine University Hospital St Anne's Brno Czech Republic

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