Trends of Cardiovascular Interventions Stratified by Body Mass Index: An Analysis of the 2016-2020 Nationwide Inpatient Sample Population

Background There is a scarcity of studies delineating the trends of cardiovascular interventions in the hospitalized population stratified by body mass index (BMI). Our study aimed to study the burden of cardiovascular interventions and outcomes by BMI. Methods We retrospectively analyzed the Nationwide Inpatient Sample (NIS) database between January 2016 and December 2020. We identified the population of interest using the International Classification of Diseases, Tenth Revision (ICD-10) code. We studied the BMI in five categories: "healthy weight" (HW; BMI < 19.9-24.9 kg/m2), "overweight" (OV; BMI = 25-29.9 kg/m2), "obesity class one" (OB1; BMI = 30-34.9 kg/m2), "obesity class two" (OB2; BMI = 35-39.9 kg/m2), and "obesity class three" (OB3; BMI > 40 kg/m2). Results There were 5,654,905 hospitalizations with an ICD-10 code related to BMI within this study period. The HW group had 1,103,659 (19.5%) hospitalizations, the OV group had 462,464 (8.2%), the OB1 group had 1,095,325 (19.4%), the OB2 group had 1,036,682 (18.3%), and the OB3 group had 1,956,775 (34.6%) hospitalizations. The mean age of the population with obesity was as follows: OB1 = 61 years (SD = 16); OB2 = 58 years (SD = 15.9); and OB3 = 55 years (SD = 15.5). The mean ages of the HW and OV groups were 68 years (SD = 16.6) and 65 years (SD = 16.1), respectively. In the HW group, there were 948 (8.1%) hospital admissions for aortic valve replacement (AVR), 54 (11%) for aortic valve repair (AVRr), 737 (15.9%) for mitral valve replacement (MVRr), 12 (17.1%) for mitral valve repair (MVR), 79 (2.2%) for left atrial appendage (LAA) closure, and 3390 (5.2%) for percutaneous coronary intervention (PCI). The OV group had 1049 (8.9%) hospital admissions for AVRs, 42 (9%) for AVRr, 461 (10%) for MVRr, four (5.7%) for MVR, 307 (8.6%) for LAA closure, and 5703 (8.8%) for PCIs. The OB1 group had 3326 (28.4%) hospital admissions for AVR, 125 (26.9%) for AVRr, 1229 (26.7%) for MVRr, 23 (32.9%) for MVR, 1173 (32.9%) for LAA, and 20,255 (31.3%) for PCI, while the OB2 group had 2725 (23.3%) hospital admissions for AVR, 105 (22.6%) for AVRr, 898 (19.4%) for MVRr, 11 (15.7%) for MVR, 933 (26.2%) for LAA, and 16,773 (25.9%) for PCI. Lastly, the OB3 group had 3626 (31%) hospital admissions for AVR, 139 (29.9%) for AVRr, 1285 (27.8%) for MVRr, 20 (28.6%) for MVR, 1063 (29.9%) for LAA, and 18,589 (28.7%) for PCI. Conclusion Our study supports the evidence of increased cardiovascular interventions with increasing BMI. Albeit, an inconsistent presentation across the spectrum of cardiovascular diseases and outcomes, for example, equal or better outcomes in obese cohorts compared to the healthy weight population undergoing PCI. However, the increasing cardiovascular intervention burden in the youngest studied population suggests a rise in the cardiovascular disease burden among the young and partially explains their better outcomes. Steps to include weight management for these patients are paramount.