Small heart-failure cohort reports weight loss but leaves short-term procedural risk uncertain

What happened

A retrospective study compared short-term safety and weight outcomes by heart-failure status after metabolic and bariatric treatment. The cohort covered 1,678 surgical or endoscopic interventions across two medical centers during 2021 to 2023.

Heart failure was present for 41 interventions, representing 2.4% of all cases. Their average age was 51, 66% were women, and mean BMI was 44. Laparoscopic sleeve gastrectomy accounted for 80% of procedures in that group. Compared with patients without heart failure, they were generally older and carried more obesity-related illness.

Within 30 days, the proportions with any recorded safety event were 24% for heart failure and 16% for the comparison. After adjustment, the odds ratio came to 1.64. Its 95% confidence interval extended from 0.76 through 3.58. That wide interval crossed 1, so the study established neither a statistically clear difference nor equivalent safety.

No patient with heart failure died within 30 days, but heart failure was associated with higher adjusted odds of an unplanned readmission. The adjusted odds ratio was 2.97, with a 95% confidence interval from 1.06 to 8.33.

Average weight change at 30 days was similar between groups, at a 5.9% reduction with heart failure and 6.2% without it. After one year, average loss among participants with heart failure equaled 18.7% of baseline weight. Use of some cardiovascular, glucose-lowering, and loop-diuretic medicines also declined over follow-up.

What it means

The study supplies early, real-world information about a high-risk population often represented by small numbers in procedural research. Selected patients with heart failure at these centers lost substantial weight during the first year.

It also identifies readmission as an outcome that deserves attention in planning and future trials. Heart-failure subtype, fluid status, kidney function, medication management, anesthesia risk, procedure choice, and the center's experience may all affect candidacy and follow-up.

What it does not mean

The study does not prove that metabolic and bariatric procedures are equally safe for patients with and without heart failure. There were only 41 heart-failure procedures, so the confidence intervals allow both little difference and a clinically important increase in risk.

The one-year weight result does not demonstrate improvement in cardiac function, symptoms, hospitalization, or survival. Medication reductions may reflect improvement, intolerance, clinician decisions, or other changes. A retrospective record review cannot show which explanation is correct.

Results from selected patients at two centers should not be generalized to every person with heart failure. The cohort mixed surgical and endoscopic interventions and cannot determine the best procedure. Prospective studies with larger samples and heart-failure-specific outcomes are still needed.