Symptoms of obese heart failure patients improved after bariatric surgery

"This tells us that bariatric surgery may become part of the treatment of patients with heart failure and obesity if there are no major contraindications for the surgery -- and that this might be especially important for patients with significant obesity," says the study's lead investigator, cardiologist Francisco Lopez-Jimenez, M.D.

He cautions, however, that because the study tested the effects of bariatric surgery on just 13 patients, "these results should be considered preliminary and suggestive of some benefit, but additional research is needed to confirm these results."

Although one-third of heart failure patients are obese, it appears that cardiologists do not often refer obese patients with heart failure for bariatric surgery, Dr. Lopez-Jimenez says.

The research team reviewed the outcomes of 13 patients, ages 44 to 64, who received bariatric surgery at Mayo Clinic in Minnesota between 1990 and 2005, as well as six heart failure patients, ages 52 to 72, who were followed in Mayo's Nutrition Clinic and did not receive the surgery.

In the group that received surgery, the mean body mass index (BMI) was 53, and in the comparison group, it was 42. After a four-year follow-up, mean BMI dropped in the surgery group to 37 and rose in the comparison group to 45.

Based on patient surveys, the researchers found that quality of life was significantly improved in those who received weight loss surgery, compared to heart failure patients who did not. Researchers also determined that symptoms such as swelling in the legs and labored breathing during exercise improved only in the surgery group.

Dr. Lopez-Jimenez points out that the health advantages seen in the patients who had bariatric surgery occurred even though most remained obese. "These patients had very advanced levels of obesity before the surgery, and although they lost significant amounts of weight, most remained obese. So, these good results suggest that the benefit does not require patients to reach a normal weight," he says.

Other authors of the study are William Miranda, M.D.; Michael Sarr, M.D.; Maria Collazo-Clavell, M.D.; Matthew Clark, Ph.D.; and Virend Somers, M.D., Ph.D.; all of Mayo Clinic, and John Batsis, M.D., Dartmouth-Hitchcock Medical Center.