Abstract 15797: Cardiovascular Outcomes of Bariatric Surgery and Anti-Obesity Medications in Patients With New Onset Heart Failure and Obesity
Bibliographic record
Abstract
Background: Intentional weight loss with bariatric surgery is associated with better outcomes in younger patients with prevalent HF. However, temporal trends in use of bariatric surgery and anti-obesity medications (AOM) among older patients with new onset HF and obesity, and their effect on CV outcomes are not well studied. Methods: Medicare patients with obesity and new onset HF from 2013 to 2019 were identified using the 100% inpatient files. Patients who underwent bariatric surgery were matched to controls in a 1:2 ratio (matched on age, sex, race, BMI, and HF diagnosis year, and comorbidities). In a random 5% sample with available Part D data, HF patients with obesity who were prescribed AOM (Semaglutide, liraglutide, naltrexone or orlistat) were identified and matched to HF controls as above. Cox models were used to evaluate the association of weight loss therapies (modeled as a time-varying dependent variable) and risk of mortality, atrial fibrillation (AF), and HF readmission rate. Results: Overall, 1.5% (2684 of 174,196) patients with new onset HF and BMI ≥35 underwent bariatric surgery (46% men, age 55 y and BMI 52 Kg/m2). Bariatric surgery use increased from 0.3% in 2013 to 1.4% in 2019 (P <0.01). In propensity-matched analyses (surgery N=2144 vs. control N=3920, f/u of 4.2 y), bariatric surgery following incident HF was associated with a significantly lower risk of mortality and new-onset AF (Figure), and a lower rate of HF readmissions (pre- vs. post-surgery rate: 0.9 vs. 0.3/100 person-days). In the subset with Part D data (N=36603), use of AOM was low (3.7%). In propensity-matched analysis, (AOM N=611 vs. controls N=891, f/u of 1.8 y), use of AOM were associated with 30% lower risk of mortality and 35% lower risk of AF compared with controls. Conclusions: Bariatric surgery and AOM are associated with favorable CV outcomes among HF patients with obesity. However, their utilization remains extremely low highlighting an important gap in care of HF patients with obesity.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".