Kamisaka K, Kamiya K, Iwatsu K, et al. - For non-obese patients suffering from heart failure (HF) with preserved ejection fraction (HFpEF), considering weight loss as an indicator for monitoring worsening of HF condition is recommended. In obese patients with HFpEF, there was no link between weight loss (WL) and adverse events, likely because of appropriate fluid management during follow-up.

• This is a multicentre cohort study of 573 patients hospitalized with HFpEF [median age: 78 years; 49.2% female].

• In non-obese patients, WL onset was linked with prior hospitalization for HF [odds ratio (OR) 2.39] and high levels of brain natriuretic peptide (OR 2.32).

• Obese patients showed an association of WL with the use of mineralocorticoid receptor antagonists (OR 3.26) and vasopressin receptor antagonists (OR 6.61).

• An association of WL with all-cause mortality (HR 5.12) and HF rehospitalization (HR 2.63) was evident post-adjustment for confounders in non-obese patients, but not in obese patients.