title: Relationship between smoking and adverse outcomes in patients with atrial fibrillation: A meta-analysis and systematic review.
abstract: BACKGROUND
  Several studies have investigated the impact of smoking on the prognosis of atrial fibrillation (AF), but the results remain controversial. We therefore aimed to estimate the association between smoking and adverse outcomes in patients with AF.
  
  
  METHODS
  We systematically searched the Cochrane Library, PubMed, and Elsevier databases through May 2016 for studies regarding the association between smoking and adverse outcomes in AF patients. Risk ratios [RRs] and 95% confidence intervals [CIs] were abstracted and then pooled using a random-effects model.
  
  
  RESULTS
  A total of 8 cohort studies with 87,373 participants were included in this meta-analysis. Among patients with AF, smoking was associated with increased risks of all-cause death (RR=1.82, 95% CI: 1.33-2.49, P=0.0002) and cardiovascular death (RR=1.54, 95% CI: 1.31-1.81, P<0.00001) but not stroke/thromboembolism (RR=1.19, 95% CI 0.97-1.46; P=0.10). In addition, smoking was associated with an increased risk of major bleeding (RR=1.93, 95% CI 1.08-3.47, P=0.03), even after adjustment for the antithrombotic treatment.
  
  
  CONCLUSIONS
  The published literature demonstrates that smoking is not associated with the risk of stroke/thromboembolism but increases the risks of all-cause death and cardiovascular death in AF patients, as well as the risk of major bleeding in AF patients using anticoagulants.
authors: Department of Cardiovascular Medicine,the Second Affiliated Hospial of Nanchang University, Nanchang, Jiangxi 330006, China.
authors: Wengen
authors: W
authors: Zhu
authors: Department of Cardiovascular Medicine,the Second Affiliated Hospial of Nanchang University, Nanchang, Jiangxi 330006, China.
authors: Linjuan
authors: L
authors: Guo
authors: Department of Cardiovascular Medicine,the Second Affiliated Hospial of Nanchang University, Nanchang, Jiangxi 330006, China; Jiangxi Key Laboratory of Molecular Medicine, Nanchang, Jiangxi 330006, China. Electronic address: hongkui88@163.com.
authors: Kui
authors: K
authors: Hong
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis / Q000401:mortality*; D002423:Cause of Death / Q000639:trends; D015331:Cohort Studies; D006470:Hemorrhage / Q000175:diagnosis / Q000401:mortality*; D006801:Humans; D012907:Smoking / Q000009:adverse effects* / Q000401:mortality*; D016896:Treatment Outcome
keywords: Atrial fibrillation; Bleeding; Death; Smoking; Stroke; Thromboembolism