Heart failure & cardiomyopathies
Sex- and phenotype-specific prognostic implications of body mass index in acute heart failure
Authors' conclusion
The prognostic implications of BMI in AHF differ according to HF phenotype and sex. Lower BMI is a consistent adverse marker in HFrEF in both sexes and shows a borderline adverse association in women with HFpEF, whereas BMI is not prognostic in men with HFpEF. These findings highlight the importance of sex- and phenotype-specific interpretation of BMI in risk assessment.
Study context
- Population
- Patients hospitalized for acute heart failure (AHF) with available data, Korean HF III registryanalyzed, from the Korean HF III registry (n = 7351)
- Participants
- 5,271 patients
- Exposure
- Body mass index (BMI) categories by HF phenotype and sex
- Outcome
- Composite of:
- All-cause mortality
- Heart transplantation
- Follow-up
- 2-year
Methodological detailsmultivariable Cox proportional hazards models, Kaplan-Meier analyses, interaction terms for BMI, sex, and HF phenotype
- Multivariable Cox proportional hazards models
- Kaplan-Meier analyses
- Interaction terms for BMI, sex, and HF phenotype
Main finding
As reported in the abstract
Hazard ratio (95% CI)P value
Higher BMIwomen with HFrEF; multivariable; lower risk with higher BMI
0.66(0.45–0.96)
P = 0.032Lower BMIwomen with HFpEF; multivariable; borderline association with higher risk
1.56(0.99–2.47)
P = 0.057Observational data: associations, not effects.
Further findings
Outcomes by BMI in HF with reduced ejection fraction (HFrEF)
- Lower BMI consistently associated with worse outcomes in both men and women
Outcomes by BMI in HF with preserved ejection fraction (HFpEF)
- BMI prognostic in women but not in men; survival differed by BMI category in Kaplan-Meier analyses for all subgroups except men with HFpEF
Original publication
Sex- and phenotype-specific prognostic implications of body mass index in acute heart failure. ESC Heart Fail. Published 25 March 2026. doi:10.
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