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Health Services Research & Development

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2005 HSR&D National Meeting Abstract


1057 — The Association Between Obesity and Coronary Procedure Utilization

Author List:
Yancy WS (Center for Health Services Research in Primary Care, VAMC, Durham, NC)
Olsen MK (Center for Health Services Research in Primary Care, VAMC, Durham, NC)
Curtis LH (Duke Clinical Research Institute, Durham, NC)
Schulman KA (Duke Clinical Research Institute, Durham, NC)
Cuffe MS (Duke Clinical Research Institute, Durham, NC)
Oddone EZ (Center for Health Services Research in Primary Care, VAMC, Durham, NC)

Objectives:
Obesity is an independent risk factor for coronary heart disease (CHD) and is associated with other risk factors for CHD, including diabetes, hypertension, and hyperlipidemia. Whereas variations in use of cardiovascular procedures based on race and gender have been evaluated extensively, the relationship between obesity and utilization of these procedures has not been examined. Our goal was to examine the relationship between body mass index (BMI) and use of coronary procedures after acute myocardial infarction (AMI).

Methods:
Using information collected for the Cooperative Cardiovascular Project, we evaluated 109,664 patients who were hospitalized for acute myocardial infarction (AMI) in acute-care hospitals between 1994-96, were >65 years of age, and were not underweight (BMI <18.5 kg/m2). Patients weighing 350 lbs or more were excluded because many cardiac catheterization tables were restricted at this weight cutoff. We used logistic regression to examine the relationship of BMI with utilization of cardiac catheterization, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG) while adjusting for patient and hospital characteristics that might influence the decision for use of these procedures.

Results:
Participants had a mean age of 75.8 (SD=7.2) years; 53% were male, 90% were Caucasian. Compared with non-obese patients, very obese (BMI >=35 kg/m2) patients were more likely to be women, non-smokers, and younger. Individuals who were overweight (BMI 25-29.9 kg/m2) or class 1 obese (30-34.9 kg/m2) had the highest rates of coronary procedure utilization. Compared with patients of BMI 25-29.9 kg/m2, class 2 obese patients (BMI 35-39.9 kg/m2) had reduced adjusted odds of receiving CABG (OR 0.88, 95% CI 0.79-0.98), while class 3 obese patients (BMI >=40 kg/m2) had the lowest odds of receiving cardiac catheterization (OR 0.82, 95% CI 0.73-0.92), PCI (OR 0.89, 95% CI 0.77-1.03), and CABG (OR 0.68, 95% CI 0.57-0.82). Patients who did not receive coronary revascularization had higher mortality than those who received it.

Implications:
For patients hospitalized with AMI, those with very high BMI were less likely than their non-obese counterparts to receive invasive coronary procedures. Utilization rates for very obese patients were comparably low to rates for women or non-White patients.

Impacts:
Very obese patients may not receive optimal care after acute myocardial infarction.


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