Feature | March 11, 2013

Weight Loss Linked to Higher Risk With ICD Implants

Study suggests increased monitoring of patients with unplanned weight loss

Weight Loss American College of Cardiology ICD Implants Risk

March 11, 2013 — Even minor weight loss is associated with worse health outcomes among patients implanted with a certain type of implantable cardioveter defibrillator known as cardiac resynchronization therapy with defibrillator (CRT-D), according to research being presented at the American College of Cardiology’s 62nd Annual Scientific Session.

People with symptoms of heart failure who have an implantable CRT-D device may believe that losing weight will ultimately improve their long-term health outcomes. However, in the first study to look at weight loss and subsequent health outcomes among patients with a CRT-D, researchers found the opposite may be true.

“In patients with heart failure who receive a cardiac resynchronization device with defibrillator, unintended weight loss of just five pounds increases the risk of a serious cardiac event,” said Valentina Kutyifa, M.D., postdoctoral research associate at the University of Rochester Medical Center and the lead author of the Multicenter Automatic Defibrillator Implantation with Cardiac Resynchronization Therapy (MADIT-CRT) trial. “These findings suggest clinicians should be monitoring patients with unplanned weight loss more closely.”

Among the subset of patients who had a specific heart condition called a left bundle branch block, the risk of heart failure or death with weight loss doubled. CRT-D devices work by emitting small electronic impulses to coordinate the heart’s rhythm and improve the ability of the heart to pump blood in patients with heart failure, and by attempting to shock the heart back into a normal rhythm when dangerous heart rhythms are detected. CRT-Ds comprise one-third of all pacemakers.

In this study, nearly 1,000 patients who received a CRT-D were observed at 12 months after implantation. Of these, nearly one in five (17 percent) had lost more than 2 kilograms, or 4.4 pounds, during that time.

These patients had a significant increase in their risk of heart failure or death compared to those without significant weight loss. In fact, each kilogram (2.2 pounds) of weight lost correlated to a 4 percent higher risk of heart failure or death.

This study fits with other studies that have looked at the “obesity paradox,” wherein overweight patients with chronic diseases such as heart disease, kidney disease or diabetes, have better health outcomes than those of normal weight. One reason for this paradox among CRT-D patients might be that heart failure causes the body to be in a catabolic state, meaning it has a high demand for energy. Heart failure patients without significant weight loss may have reserves that better allow their bodies to tolerate this high-energy demand, Kutyifa said.

Study authors caution that their findings are not a prescription for patients to pack on the pounds. “We would still recommend weight control under a physician’s supervision since we know that obesity is associated with other serious diseases including diabetes, high blood pressure, coronary artery disease and sleep apnea,” Kutyifa said. “Heart failure patients should continue to follow their clinicians’ advice in regards to diet and lifestyle changes.”

According to Kutyifa, more research is needed to examine the effects of weight loss among heart failure patients with pacemakers in prospective clinical trials. The MADIT-CRT trial was supported by a research grant from Boston Scientific, St. Paul, Minn.

For more information: cardiosource.org

Related Content

cardiac surgery, simulation training, University of Washington, case studies

Multiple repetitions of bypass grafts on a heart, using the Ramphal simulator. Courtesy of the University of Washington in Seattle.

News | Cardiovascular Surgery| August 25, 2016
August 25, 2016 — Simulation training fo
aortic dissection, family history, same age, clinical study, John A. Elefteriades, Annals of Thoracic Surgery
News | Structural Heart| August 25, 2016
People with a family member who had an aortic dissection — a spontaneous tear in one of the body’s main arteries —...
Intact Vascular, TOBA clinical study, one-year results, Tack Endovascular System, Journal of Vascular Surgery
News | Peripheral Arterial Disease (PAD)| August 24, 2016
Intact Vascular Inc. announced that the one-year results from its Tack Optimized Balloon Angioplasty (TOBA) clinical...
nanoparticles, blood clotting, internal bleeding, American Chemical Society study, Erin B. Lavik

Nanoparticles (green) help form clots in an injured liver. The researchers added color to the scanning electron microscopy image after it was taken. Image courtesy of Erin Lavik, Ph.D.

News | Hemostasis Management| August 24, 2016
August 24, 2016 — Whether severe trauma occurs on the battlefield or the highway, saving lives often comes down to...
News | Heart Failure| August 23, 2016
August 23, 2016 — A new study of more than 13,000 people has found that so-called morbid obesity appears to stand alo
Jason Burdick, injectable hydrogels, heart failure, heart attack, American Chemical Society

Compared to other types of hydrogels being developed (left), a new hydrogel (right) can form crosslinks after injection into the heart, making the material stiffer and longer-lasting. Image courtesy of American Chemical Society.

News | Heart Failure| August 23, 2016
August 23, 2016 — During a heart attack, clots or narrowed arteries block blood flow, harming or killing cells within
EpiAccess System, EpiEP, Mount Sinai New York, epicardial access
News | Ablation Systems| August 22, 2016
August 22, 2016 — The Mount Sinai Hospital is the first site in the New York metropolitan area to pioneer a new appro
sleep apnea, hypertension, clinical study, Science Signaling, University of Chicago
News | Hypertension| August 22, 2016
Obstructive sleep apnea is a common cause of high blood pressure. In the Aug. 17, 2016, issue of the journal Science...
TAILOR-PCI study, antiplatelet medication, genotype, NHLBI grant
News | Antiplatelet and Anticoagulation Therapies| August 18, 2016
Researchers at the Peter Munk Cardiac Centre, Toronto, and at Mayo Clinic are leading the Tailored Antiplatelet Therapy...
warfarin, long-term stability, atrial fibrillation, DCRI study, Sean Pokorney
News | Antiplatelet and Anticoagulation Therapies| August 16, 2016
August 16, 2016 — Warfarin prescribed to prevent strokes in...
Overlay Init