The effect of bariatric surgery on patient reported outcomes of heart failure in women: a pilot study.

BACKGROUND: Heart failure (HF) with preserved ejection fraction (HFpEF) disproportionately affects women, with obesity serving as a significant risk factor. Metabolic and bariatric surgery (MBS) has been associated with reduced risk of HF development and may reverse cardiac geometry and metabolic abnormalities that contribute to impaired cardiac function through weight loss dependent and independent mechanisms. However, the impact of MBS on early patient reported outcomes of HF in female patients remains understudied. OBJECTIVE: The purpose of this pilot study was to determine the early impact of MBS on female patient reported outcomes for HF. SETTING: Academic Medical Center, USA. METHODS: Female patients with morbid obesity were recruited from our institution between 2022 and 2025. They were evaluated in a multidisciplinary fashion, consented, and scheduled for a sleeve gastrectomy (SG) prior to screening and study enrollment. Female patients with and without HFpEF or diastolic dysfunction (DD) were included in the study. Inclusion criteria involved adults 18-60 years of age without HF with reduced ejection fraction. Patients completed the Patient Reported Outcomes Measurement Information System Heart Failure 27 (PROMIS HF 27) profile to evaluate psychometric and physical health characteristics 2weeks before and 6weeks after surgery. The primary endpoint was the change from baseline in the PROMIS HF 27 profile. RESULTS: A total of 27 female patients consented to and enrolled in the study. Six subjects had HFpEF/DD and 21 patients were control subjects. Demographic variables between HFpEF/DD and control groups were similar except for HFpEF/DD patients being older than controls (52.3 ± 4.2 versus 42.3 ± 10.4, P = .002). There were no statistically significant adverse outcomes within the 30-day postoperative period for both groups. Six weeks postoperatively, control subjects showed improvements in PROMIS HF 27 summary scores including physical health (68.5 ± 22.3 versus 81.3 ± 17.3 P < .001), mental health (61.2 ± 19.6 versus 68.3 ± 12.9, P = .038), 56.3 ± 24.9 versus 67.1 ± 14.5, P = .03), social health (75.0 ± 30.0 versus 86.1 ± 20.2, P = .034), and overall health (68.3 ± 22.1 versus 79.3 ± 14.9, P = .001). HFpEF/DD patients demonstrated improvements in physical health (52.7 ± 28.1 versus 64.3 ± 25.0, P = .02) and overall health outcomes after surgery (53.1 ± 30.6 versus 66.4 ± 19.8 P = .05). CONCLUSIONS: MBS, specifically SG, appears to be associated with improvements in patient reported HF outcomes among female patients with obesity. Female patients with HFpEF/DD specifically reported meaningful changes to physical and overall health, including a statistically significant reduction in dyspnea, highlighting a tangible improvement in early, symptom burden in this high-risk population. Finally, the observed improvements in various HF outcomes among control patients highlight the intricate relationship between HF symptoms and obesity itself which can be positively influenced by MBS. These findings underscore the benefits of MBS in enhancing quality of life and cardiopulmonary symptom burden in women with obesity while also highlighting distinct postoperative response patterns in patients with HFpEF/DD.