Outcomes Associated With Surgical and Pharmacologic Treatment of Obesity in Heart Failure.
Outcomes Associated With Surgical and Pharmacologic Treatment of Obesity in Heart Failure.
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与心力衰竭肥胖症的手术和药物治疗相关的结果。
DOI：
10.1161/circheartfailure.123.011323
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发表时间：
2024
期刊：
影响因子：
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通讯作者：
Powell-Wiley,TiffanyM
中科院分区：
文献类型：
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作者：
Claudel,SophieE;Powell-Wiley,TiffanyM
这篇文章强调了几个关键的发现，包括减肥手术与降低全因死亡率、降低心力衰竭住院率和降低房颤发生率显著相关。然而，社会经济地位较低的患者不太可能接受减肥手术，而合并症较少的患者更有可能接受手术。在研究期间，通过减肥手术治疗肥胖的比例显著增加，从2013年的0.2%增加到2020年的1.0%，但总体上仍然很低。作者还纳入了对已知可诱导体重减轻的药物治疗（包括西马鲁肽、利拉鲁肽、纳曲酮-安非他酮或奥利司他）的分析。这些药物与降低全因死亡率和降低心力衰竭住院率显著相关，但与降低房颤发生率无关。总的来说，在射血分数降低的心力衰竭患者和保留射血分数（HFpEF）的心力衰竭患者之间，与减肥手术和药物治疗相关的研究结果是一致的。最后，考虑到减肥手术和药物治疗，在心力衰竭住院后，抗肥胖治疗的开始有很大的延迟。本研究扩展了先前关于有意减肥在改善心力衰竭患者心血管预后中的作用的研究，并为老年心力衰竭患者减肥手术的应用提供了一个真实的视角。作者得出结论，减肥手术
There are several key findings highlighted in this article, including that bariatric surgery was significantly associated with decreased all-cause mortality, decreased hospitalization for heart failure, and decreased incidence of atrial fibrillation. However, patients of lower socioeconomic status were less likely to undergo bariatric surgery, and patients who had fewer comorbidities were more likely to have surgery. Treatment of obesity with bariatric surgery increased significantly over the study period, from 0.2% in 2013 to 1.0% in 2020, but remained low overall. The authors also included analyses focusing on pharmacotherapies known to induce weight loss (including semaglutide, liraglutide, naltrexone-bupropion, or orlistat). These medications were significantly associated with decreased all-cause mortality and decreased hospitalization for heart failure but not decreased incidence of atrial fibrillation. Overall, the findings related to both bariatric surgery and pharmacotherapy were consistent between patients with heart failure with reduced ejection fraction and heart failure with preserved ejection fraction (HFpEF). Finally, there was a substantial delay in the initiation of antiobesity treatment following the index hospitalization for heart failure when considering both bariatric surgery and pharmacotherapy. This study expands prior work examining the role of intentional weight loss in improving cardiovascular outcomes in heart failure and provides a real-world view of bariatric surgery utilization among older patients with heart failure. The authors conclude that bariatric surgery