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A smoker's paradox in patients hospitalized for heart failure: findings from OPTIMIZE-HF.
Eur Heart J. 2008 Aug; 29(16):1983-91.EH

Abstract

AIMS

Cigarette smoking is a well-established risk factor for cardiovascular disease yet several studies have shown lower mortality after acute coronary syndromes in smokers compared with non-smokers, the so called 'smoker's paradox'. This study aimed to ascertain the relationship between smoking and clinical outcomes in patients hospitalized with heart failure (HF).

METHODS AND RESULTS

OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) collected data on 48 612 patients from 259 hospitals. Characteristics, treatments, and outcomes were compared for current/recent smokers vs. those without current/recent smoking, and multivariable regression analyses with adjustment for hospital clustering were performed. There were 7743 (15.9%) smokers, 39 126 (80.5%) non-smokers, and 1743 (3.6%) missing. Smokers were younger, had similar renal function, but lower ejection fraction. The risk of in-hospital mortality was less in smokers (2.3 vs. 3.9%, P < 0.001). After extensive covariate adjustment, smokers still had lower in-hospital mortality risk OR (odds ratio) 0.70, 95% CI (confidence interval) 0.56-0.88, P = 0.002. Post-discharge, smokers (n = 998) had similar mortality risk (6.7 vs. 8.4%, P = 0.29) compared with those without current/recent smoking.

CONCLUSION

Smokers hospitalized with HF had lower risk adjusted in-hospital mortality and similar early post-discharge mortality compared with non-smokers. The residual association of smoking and better prognosis, the 'smoker's paradox', was not fully explained by measured covariates.

Authors+Show Affiliations

Department of Medicine, UCLA Medical Center, Los Angeles, CA, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18487210

Citation

Fonarow, Gregg C., et al. "A Smoker's Paradox in Patients Hospitalized for Heart Failure: Findings From OPTIMIZE-HF." European Heart Journal, vol. 29, no. 16, 2008, pp. 1983-91.
Fonarow GC, Abraham WT, Albert NM, et al. A smoker's paradox in patients hospitalized for heart failure: findings from OPTIMIZE-HF. Eur Heart J. 2008;29(16):1983-91.
Fonarow, G. C., Abraham, W. T., Albert, N. M., Stough, W. G., Gheorghiade, M., Greenberg, B. H., O'Connor, C. M., Nunez, E., Yancy, C. W., & Young, J. B. (2008). A smoker's paradox in patients hospitalized for heart failure: findings from OPTIMIZE-HF. European Heart Journal, 29(16), 1983-91. https://doi.org/10.1093/eurheartj/ehn210
Fonarow GC, et al. A Smoker's Paradox in Patients Hospitalized for Heart Failure: Findings From OPTIMIZE-HF. Eur Heart J. 2008;29(16):1983-91. PubMed PMID: 18487210.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A smoker's paradox in patients hospitalized for heart failure: findings from OPTIMIZE-HF. AU - Fonarow,Gregg C, AU - Abraham,William T, AU - Albert,Nancy M, AU - Stough,Wendy Gattis, AU - Gheorghiade,Mihai, AU - Greenberg,Barry H, AU - O'Connor,Christopher M, AU - Nunez,Eduardo, AU - Yancy,Clyde W, AU - Young,James B, Y1 - 2008/05/15/ PY - 2008/5/20/pubmed PY - 2009/2/6/medline PY - 2008/5/20/entrez SP - 1983 EP - 91 JF - European heart journal JO - Eur Heart J VL - 29 IS - 16 N2 - AIMS: Cigarette smoking is a well-established risk factor for cardiovascular disease yet several studies have shown lower mortality after acute coronary syndromes in smokers compared with non-smokers, the so called 'smoker's paradox'. This study aimed to ascertain the relationship between smoking and clinical outcomes in patients hospitalized with heart failure (HF). METHODS AND RESULTS: OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) collected data on 48 612 patients from 259 hospitals. Characteristics, treatments, and outcomes were compared for current/recent smokers vs. those without current/recent smoking, and multivariable regression analyses with adjustment for hospital clustering were performed. There were 7743 (15.9%) smokers, 39 126 (80.5%) non-smokers, and 1743 (3.6%) missing. Smokers were younger, had similar renal function, but lower ejection fraction. The risk of in-hospital mortality was less in smokers (2.3 vs. 3.9%, P < 0.001). After extensive covariate adjustment, smokers still had lower in-hospital mortality risk OR (odds ratio) 0.70, 95% CI (confidence interval) 0.56-0.88, P = 0.002. Post-discharge, smokers (n = 998) had similar mortality risk (6.7 vs. 8.4%, P = 0.29) compared with those without current/recent smoking. CONCLUSION: Smokers hospitalized with HF had lower risk adjusted in-hospital mortality and similar early post-discharge mortality compared with non-smokers. The residual association of smoking and better prognosis, the 'smoker's paradox', was not fully explained by measured covariates. SN - 1522-9645 UR - https://www.unboundmedicine.com/medline/citation/18487210/A_smoker's_paradox_in_patients_hospitalized_for_heart_failure:_findings_from_OPTIMIZE_HF_ L2 - https://academic.oup.com/eurheartj/article-lookup/doi/10.1093/eurheartj/ehn210 DB - PRIME DP - Unbound Medicine ER -