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


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.


CONCLUSIONS
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.
Fonarow
Gregg C
GC
Department of Medicine, UCLA Medical Center, Los Angeles, CA, USA.
Abraham
William T
WT
Albert
Nancy M
NM
Stough
Wendy Gattis
WG
Gheorghiade
Mihai
M
Greenberg
Barry H
BH
O'Connor
Christopher M
CM
Nunez
Eduardo
E
Yancy
Clyde W
CW
Young
James B
JB
D000367:Age Factors; D000368:Aged; D004812:Epidemiologic Methods; D005260:Female; D006333:Heart Failure / Q000401:mortality*; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012907:Smoking / Q000401:mortality*; D016540:Smoking Cessation; D000074606:Smoking Prevention; D014481:United States / Q000453:epidemiology