Efficacy of Cardiac Rehabilitation in Heart Failure Patients With Low Body Mass Index

Background: Low body mass index (BMI) is a relevant prognostic factor for heart failure (HF), but HF patients with low BMI are reported to be at risk of not receiving optimal drug treatment. We sought to evaluate the efficacy of cardiac rehabilitation (CR) in patients with low vs. normal BMI. Methods and Results: We studied 152 consecutive patients (low BMI, n=32; normal BMI, n=119) who participated in a 3-month CR program. Low BMI was defined as <18.5 kg/m(2) and normal BMI, as 18.5 <= BMI<25 kg/m(2). All patients underwent cardiopulmonary exercise testing and muscle strength testing at the beginning and end of the 3-month CR program. After CR, a significantly greater proportion of HF patients with low BMI had a positive change in peak (V) over dot O-2 than in the normal BMI group (91% vs. 70%; P=0.010). Average percent change in peak (V) over dot O-2 was significantly greater in patients with low vs. normal BMI (17.1 +/- 2.8% vs. 7.8 +/- 1.5%; P<0.001). In addition, on multivariable logistic regression, low BMI was an independent predictor of a positive change in peak (V) over dot O-2 after CR (OR, 3.97; 95% CI: 1.10-14.31; P=0.035). Conclusions: CR has a greater effect in patients with low than normal BMI, and low BMI is an independent predictor of a positive change in peak (V) over dot O-2 Thus, CR should be strongly recommended for HF patients with low BMI.