A smoker's paradox in patients hospitalized for heart failure: findings from OPTIMIZE-HF

作者：Fonarow Gregg C^*; Abraham William T; Albert Nancy M; Stough Wendy Gattis; Gheorghiade Mihai; Greenberg Barry H; O'Connor Christopher M; Nunez Eduardo; Yancy Clyde W; Young James B

来源：European Heart Journal, 2008, 29(16): 1983-1991.

DOI：10.1093/eurheartj/ehn210

• heart failure
• smoking
• registry
• mortality
• hospitalization

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).
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.
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.

• 出版日期2008-8
• 单位西北大学