title: Smoking Status at Time of Listing for a Heart Transplant Predicts Mortality on the Waiting List: A Multicenter Prospective Observational Study.
abstract: OBJECTIVE
  We examined the association of smoking status at time of listing with waitlist mortality among heart transplant (HTx) candidates.
  
  
  METHODS
  Data were analyzed from 316 participants (aged 53 ± 11; 18% female) of the Waiting for a New Heart Study, a prospective observational study of patients newly listed for HTx at 17 hospitals.
  
  
  RESULTS
  During the study period (April 2005 to March 2010), 14% of those who never smoked died, 18% among former smokers died, and almost half (42%) died among those who reported smoking at time of wait listing. Multivariate Cox regression models controlling for age, sex, and disease severity revealed smoking at time of listing was associated with significantly higher risk of mortality compared to never smoking (hazard ratio [HR] = 3.43; P = .03). The relationship between smoking and mortality risk appeared to follow a dose-dependent pattern: adjusted HRs were 1.80 for those who quit ≤1 year ago, 1.25 for those who quit >1 to 10 years ago, and 0.90 for those quit >10 years ago, compared to never smokers. Smoking at time of listing may increase risk of mortality during the waiting period, indicating the need for improved strategies to achieve smoking cessation as early as possible in the course of HTx.
authors.affiliation: Department of Public Health, University of California, Merced, CA, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Gali
authors.affiliation: Department of Health Psychology, Trier University, Trier, Germany.
authors.forename: Heike
authors.initials: H
authors.lastname: Spaderna
authors.affiliation: Eurotransplant International Foundation, Leiden, the Netherlands.
authors.forename: Jacqueline M A
authors.initials: JM
authors.lastname: Smits
authors.affiliation: School of Medicine, Bond University, Queensland, Australia.
authors.forename: Katrina A
authors.initials: KA
authors.lastname: Bramstedt
authors.affiliation: Department of Biology, San Francisco State University, San Francisco, CA, USA gweidner@sfsu.edu.
authors.forename: Gerdi
authors.initials: G
authors.lastname: Weidner
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000601:surgery; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012907:Smoking / Q000453:epidemiology*; D016540:Smoking Cessation / Q000706:statistics & numerical data*; D013997:Time Factors; D014850:Waiting Lists / Q000401:mortality*
keywords: heart failure; heart transplant waitlist; mortality; smoking; tobacco use