REVISITING THE PROGNOSTIC MEANING OF BODY MASS INDEX AFTER HFREF HOSPITALIZATION USING DAYS ALIVE AND OUT OF HOSPITAL: INSIGHTS FROM THE SINGCLOUD COHORT
Author(s)
Sibo Liu, MS, PhD Candidate1, Nicholas Graves, PhD1, Audry Lee, MRCP2, Chun Fan Lee, PhD3, Sameera Senanayake, MD, PhD1, Khung Keong Yeo, MBBS2, Derek Hausenloy, PhD4, Sanjeewa Kularatna, MD, PhD1.
1Health Services Research & Population Health (HSRPH), Duke-NUS Medical School, Singapore, Singapore, 2Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore, 3Centre for Biomedical Data Science (CBDS), Duke-NUS Medical School, Singapore, Singapore, 4Cardiovascular & Metabolic Disorders (CVMD) Program, Duke-NUS Medical School, Singapore, Singapore.
1Health Services Research & Population Health (HSRPH), Duke-NUS Medical School, Singapore, Singapore, 2Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore, 3Centre for Biomedical Data Science (CBDS), Duke-NUS Medical School, Singapore, Singapore, 4Cardiovascular & Metabolic Disorders (CVMD) Program, Duke-NUS Medical School, Singapore, Singapore.
OBJECTIVES: In established heart failure, efforts to clarify body mass index (BMI) prognosis often focus on alternative adiposity or anthropometric measures. We instead revisited this key clinical question from the outcome side using days alive and out of hospital (DAOH), a patient-centered outcome that captures cumulative post-discharge health. We examined whether BMI-related prognosis after heart failure with reduced ejection fraction (HFrEF) hospitalization differed across conventional endpoints, 1-year DAOH, and DAOH components.
METHODS: We conducted a nationwide registry-based cohort study using the Singapore Cardiovascular Longitudinal Outcomes Database (SingCLOUD). Patients discharged alive after an index HFrEF hospitalization between 2011-2021 were included. Outcomes were 1-year post-discharge DAOH, all-cause mortality, and first all-cause rehospitalization and/or death. Percentage DAOH was modeled using zero-one-inflated beta regression. To aid interpretation, we further examined two DAOH components: the probability of an entirely event-free year and event-conditioned DAOH among patients with rehospitalization and/or death. BMI was modeled flexibly and associations were assessed by sex.
RESULTS: Among 11,087 patients (mean age 68.5 ± 13.3 years; 31.4% women), mean 1-year DAOH was 308.6 ± 102.4 days. Lower BMI was consistently associated with higher mortality and fewer DAOH in both sexes. At higher BMI, mortality analyses suggested possible but imprecise sex-specific associations. DAOH component analyses localized the clearest sex-specific pattern to event-conditioned DAOH (P-interaction=0.033), showing an increase-then-plateau pattern among men whereas an inverse U-shaped pattern among women. At BMI 18.5 kg/m2, adjusted event-conditioned DAOH was 258.4 days (95% CI, 253.7-263.1) in men and 264.5 days (95% CI, 258.7-270.3) in women; at BMI 30.0 kg/m2, the corresponding estimates were 269.4 days (95% CI, 265.3-273.4) and 265.7 days (95% CI, 259.7-271.7).
CONCLUSIONS: By approaching BMI prognosis from the outcome side, DAOH complemented mortality and first-event endpoints by revealing sex-specific patterns in cumulative post-discharge health. These findings support the use of DAOH to inform burden-based and sex-aware post-discharge prognostication.
METHODS: We conducted a nationwide registry-based cohort study using the Singapore Cardiovascular Longitudinal Outcomes Database (SingCLOUD). Patients discharged alive after an index HFrEF hospitalization between 2011-2021 were included. Outcomes were 1-year post-discharge DAOH, all-cause mortality, and first all-cause rehospitalization and/or death. Percentage DAOH was modeled using zero-one-inflated beta regression. To aid interpretation, we further examined two DAOH components: the probability of an entirely event-free year and event-conditioned DAOH among patients with rehospitalization and/or death. BMI was modeled flexibly and associations were assessed by sex.
RESULTS: Among 11,087 patients (mean age 68.5 ± 13.3 years; 31.4% women), mean 1-year DAOH was 308.6 ± 102.4 days. Lower BMI was consistently associated with higher mortality and fewer DAOH in both sexes. At higher BMI, mortality analyses suggested possible but imprecise sex-specific associations. DAOH component analyses localized the clearest sex-specific pattern to event-conditioned DAOH (P-interaction=0.033), showing an increase-then-plateau pattern among men whereas an inverse U-shaped pattern among women. At BMI 18.5 kg/m2, adjusted event-conditioned DAOH was 258.4 days (95% CI, 253.7-263.1) in men and 264.5 days (95% CI, 258.7-270.3) in women; at BMI 30.0 kg/m2, the corresponding estimates were 269.4 days (95% CI, 265.3-273.4) and 265.7 days (95% CI, 259.7-271.7).
CONCLUSIONS: By approaching BMI prognosis from the outcome side, DAOH complemented mortality and first-event endpoints by revealing sex-specific patterns in cumulative post-discharge health. These findings support the use of DAOH to inform burden-based and sex-aware post-discharge prognostication.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
CO189
Topic
Clinical Outcomes
Topic Subcategory
Clinical Outcomes Assessment
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory)