European Heart Journal Advance Access published online on May 15, 2008
European Heart Journal, doi:10.1093/eurheartj/ehn210
A smoker's paradox in patients hospitalized for heart failure: findings from OPTIMIZE-HF
1 Department of Medicine, UCLA Medical Center, Los Angeles, CA, USA
2 Division of Cardiology, The Ohio State University, Columbus, OH, USA
3 George M. and Linda H. Kaufman Center for Heart Failure, Cleveland Clinic Foundation, Cleveland, OH, USA
4 Department of Medicine, Duke University Medical Center, Durham, NC, USA
5 Department of Clinical Research, Campbell University School of Pharmacy, Research Triangle Park, NC, USA
6 Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
7 Department of Medicine, USCD Medical Center, University of California, San Diego, CA, USA
8 Division of Cardiology, Duke University Medical Center/Duke Clinical Research Institute, Durham, NC, USA
9 GlaxoSmithKline, Philadelphia, PA, USA
10 Baylor University Medical Center, Dallas, TX, USA
11 Department of Cardiovascular Medicine, Heart Failure Section, Cleveland Clinic Foundation, Cleveland, OH, USA
Received 4 February 2008; revised 17 April 2008; accepted 28 April 2008.
* Corresponding author: Ahmanson-UCLA Cardiomyopathy Center, UCLA Medical Center, 10833 LeConte Avenue, Room 47-123 CHS, Los Angeles, CA 90095-1679, USA. Tel: +1 310 206 9112, Fax: +1 310 206 9111, Email: gfonarow{at}mednet.ucla.edu
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.
Key Words: Heart failure • Smoking • Registry • Mortality • Hospitalization
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