The relationship between obesity and long-term outcomes in heart failure with preserved ejection fraction (HFpEF) remains incompletely understood. In an analysis from the HF-POL registry presented at the Heart Failure 2026, investigators evaluated the impact of obesity on clinical characteristics and 1-year outcomes in patients with HFpEF.

HF-POL is a multicenter prospective observational registry conducted across 14 centers in Poland. Between October 2021 and June 2022, the registry enrolled 1,497 consecutive patients with heart failure and ejection fraction >40%, including 743 patients with HFpEF.

Findings

• Obese patients with HFpEF were slightly younger than non-obese patients.
• Obesity was associated with a greater burden of comorbidities, including diabetes, hypertension, chronic kidney disease, peripheral artery disease, atrial fibrillation, and peripheral edema.
• Despite similar hemodynamic profiles, obese patients had significantly lower NT-proBNP levels.
• Obese patients more frequently demonstrated non-ischemic heart failure etiologies, suggesting a metabolic and comorbidity-associated HFpEF phenotype.
• Use of angiotensin receptor blockers, calcium-channel blockers, sodium-glucose cotransporter-2 inhibitors, and diuretics was more frequent in obese patients.
• During 1-year follow-up, obese patients experienced more heart failure hospitalizations compared with non-obese patients (30.29% vs 22.38%).
• In contrast, all-cause mortality was lower among obese patients than among non-obese patients (12.13% vs 17.86%; p=0.037).

The findings suggest that obesity in HFpEF is associated with a distinct clinical phenotype characterized by greater comorbidity burden and increased risk of heart failure hospitalization, despite lower short-term mortality.