IN THE NEWS
SEPTEMBER 2021 / GENERAL SURGERY NEWS
Bariatric Surgery Decreases Hospital al Admissions for Diastolic Heart Failure By KATE O’ROURKE
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ariatric surgery decreases the number of hospital admissions for diastolic heart failure in severely obese patients, according to new research presented at the 2021 annual meeting of the American Society for Metabolic and Bariatric Surgery (abstract A008). According to David Funes, MD, a research fellow at Cleveland Clinic in Weston, Fla., who presented the research, for more than 16 years, the objective of medical therapy in diastolic heart failure has been to decrease hospital admissions and mortality. Unfortunately, all randomized trials have failed to demonstrate efficacy of medical therapy in these important clinical outcomes. Dr. Funes said the only medication that has proven modest impact to prevent hospitalizations in this patient population is candesartan. In the new study, the researchers’ primary objective was to evaluate the hypothesis that bariatric surgery is associated with a decrease in hospital admissions for diastolic heart failure in severely obese patients. The researchers conducted a retrospective analysis of the National Inpatient Sample database from the years 2010 to 2015, dividing patients into those with and without a history of bariatric surgery. They analyzed all covariates associated with morbidity and mortality for diastolic heart failure including hypertension, diabetes mellitus, smoking, coronary artery disease, race, age and sex. The multivariate logistic regression analysis demonstrated that the patients who did not undergo bariatric surgery were at a significantly higher risk for being admitted for acute and chronic diastolic heart failure. “Patients in the control group with no history of hypertension were almost five times more likely to be admitted for acute diastolic heart failure,” Dr. Funes said. “Furthermore, the odds of prevalence for chronic diastolic heart failure were two times higher in the control group when compared to their counterparts in the control group. … The multivariate logistic regression analysis demonstrated that the odds of hospitalization for diastolic heart failure, specifically for patients with a history of coronary artery disease, was almost three times higher in the control group when compared to the surgical group.” Tammy Kindel, MD, PhD, an associate professor and the director of the bariatric surgery program at the University of Wisconsin–Milwaukee, who served
as the discussant of the study, pointed out h that heart failure with preserved ejection fraction (HFpEF) is closely associated with obesity and w hypertension and is now representing 50% of casess of heart failure. She said it
is a distinct pathophysiologic phenotype from heart failure with reduced ejection fraction. “HFpEF has significant morbidity and mortality, as mentioned, and there really is no effecti tive medical treatment cap capable of reducing heart
failure–related mortality,” Dr. Kindel said. “Although it would seem that obesity treatment would be essential, there really are minimal studies demonstrating that weight loss, in any form, can modify diastolic dysfunction in HFpEF patients. Your group has really added an important article to the literature where there is a true void and considerable knowl■ edge gap.”
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Warnings and Precautions Specific to EXPAREL Avoid additional use of local anesthetics within 96 hours following administration of EXPAREL. EXPAREL is not recommended for the following types or ©2021 Pacira BioSciences, Inc. Parsippany, NJ 07054 PP-EX-US-6517 03/21
Please refer to brief summary of Prescribing Information on adjacent page. For more information, please visit www.EXPAREL.com or call 1-855-793-9727. Reference: 1. Data on File. 6450. Parsippany, NJ: Pacira BioSciences, Inc.; January 2021.
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