title: Effects of smoking in patients treated with cardiac resynchronization therapy.
abstract: Smoking is associated with increased morbidity and mortality in cardiac patients. However, data on the prognostic impact of smoking in heart failure (HF) patients on cardiac resynchronization therapy with defibrillator (CRT-D) are absent. We investigated the effects of smoking on all-cause mortality and on a composite endpoint (all-cause death/appropriate device therapy), appropriate and inappropriate device therapy, in 649 patients with HF who underwent CRT-D between January 2003 and October 2011 in 6 Centers (4 in Italy and 2 in USA). 68 patients were current smokers, 396 previous-smokers (patients who had smoked in the past but who had quit before the CRT-D implant), and 185 had never smoked. The risk of each endpoint by smoking status was evaluated with both Kaplan-Meier and Cox proportional-hazard analysis. After adjusting for age, left ventricular ejection fraction, QRS width and ischemic etiology, both current and previous smoking were independent predictors of all-cause death [HR = 5.07 (95 % CI 2.68-9.58), p < 0.001 and HR = 2.43 (95 % CI 1.38-4.29), p = 0.002, respectively) and of composite endpoint [HR = 1.63 (1.04-2.56); p = 0.033 and HR = 1.46 (1.04-2.04) p = 0.027]. In addition, current smokers had a significantly higher rate of inappropriate device therapy compared to never smokers [HR = 21.74 (4.53-104.25), p = 0.005]. Our study indicates that in patients with HF who received a CRT-D device, current and previous smoking increase the event rate per person-time of death and of appropriate and inappropriate ICD therapy more than other known negative prognostic factors such as age, left ventricular dysfunction, prolonged QRS duration and ischemic etiology.
authors.affiliation: University of Florence, Viale Morgagni 85, 50134, Florence, Italy, laura_perrotta81@hotmail.com.
authors.forename: Laura
authors.initials: L
authors.lastname: Perrotta
authors.forename: Brunilda
authors.initials: B
authors.lastname: Xhaferi
authors.forename: Marco
authors.initials: M
authors.lastname: Chiostri
authors.forename: Paolo
authors.initials: P
authors.lastname: Pieragnoli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ricciardi
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Biase
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
authors.forename: Ilaria
authors.initials: I
authors.lastname: Ricceri
authors.forename: Mazda
authors.initials: M
authors.lastname: Biria
authors.forename: Dhanunjay
authors.initials: D
authors.lastname: Lakkireddy
authors.forename: Alessandro
authors.initials: A
authors.lastname: Valleggi
authors.forename: Michele
authors.initials: M
authors.lastname: Emdin
authors.forename: Federica
authors.initials: F
authors.lastname: Michelotti
authors.forename: Giosuè
authors.initials: G
authors.lastname: Mascioli
authors.forename: Angela
authors.initials: A
authors.lastname: Pandozi
authors.forename: Massimo
authors.initials: M
authors.lastname: Santini
authors.forename: Luigi
authors.initials: L
authors.lastname: Padeletti
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012907:Smoking / Q000009:adverse effects*