A smoker's paradox in patients hospitalized for heart failure: findings from OPTIMIZE-HF
Identifieur interne : 004236 ( Main/Exploration ); précédent : 004235; suivant : 004237A smoker's paradox in patients hospitalized for heart failure: findings from OPTIMIZE-HF
Auteurs : Gregg C. Fonarow [États-Unis] ; William T. Abraham [États-Unis] ; Nancy M. Albert [États-Unis] ; Wendy Gattis Stough [États-Unis] ; Mihai Gheorghiade [États-Unis] ; Barry H. Greenberg [États-Unis] ; Christopher M. O'Connor [États-Unis] ; Eduardo Nunez [États-Unis] ; Clyde W. Yancy [États-Unis] ; James B. Young [États-Unis]Source :
- European Heart Journal [ 0195-668X ] ; 2008-08.
Abstract
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.
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DOI: 10.1093/eurheartj/ehn210
Affiliations:
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Albert</name></author><author><name sortKey="Stough, Wendy Gattis" sort="Stough, Wendy Gattis" uniqKey="Stough W" first="Wendy Gattis" last="Stough">Wendy Gattis Stough</name></author><author><name sortKey="Gheorghiade, Mihai" sort="Gheorghiade, Mihai" uniqKey="Gheorghiade M" first="Mihai" last="Gheorghiade">Mihai Gheorghiade</name></author><author><name sortKey="Greenberg, Barry H" sort="Greenberg, Barry H" uniqKey="Greenberg B" first="Barry H." last="Greenberg">Barry H. Greenberg</name></author><author><name sortKey="O Connor, Christopher M" sort="O Connor, Christopher M" uniqKey="O Connor C" first="Christopher M." last="O'Connor">Christopher M. O'Connor</name></author><author><name sortKey="Nunez, Eduardo" sort="Nunez, Eduardo" uniqKey="Nunez E" first="Eduardo" last="Nunez">Eduardo Nunez</name></author><author><name sortKey="Yancy, Clyde W" sort="Yancy, Clyde W" uniqKey="Yancy C" first="Clyde W." last="Yancy">Clyde W. 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Fonarow</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Medicine, UCLA Medical Center, Los Angeles, CA</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation><affiliation wicri:level="1"><country wicri:rule="url">États-Unis</country></affiliation><affiliation><wicri:noCountry code="syntax">???</wicri:noCountry></affiliation><affiliation wicri:level="1"><country wicri:rule="url">États-Unis</country></affiliation></author><author><name sortKey="Abraham, William T" sort="Abraham, William T" uniqKey="Abraham W" first="William T." last="Abraham">William T. Abraham</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Cardiology, The Ohio State University, Columbus, OH</wicri:regionArea><placeName><region type="state">Ohio</region></placeName></affiliation></author><author><name sortKey="Albert, Nancy M" sort="Albert, Nancy M" uniqKey="Albert N" first="Nancy M." last="Albert">Nancy M. Albert</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>George M. and Linda H. Kaufman Center for Heart Failure, Cleveland Clinic Foundation, Cleveland, OH</wicri:regionArea><placeName><region type="state">Ohio</region></placeName></affiliation></author><author><name sortKey="Stough, Wendy Gattis" sort="Stough, Wendy Gattis" uniqKey="Stough W" first="Wendy Gattis" last="Stough">Wendy Gattis Stough</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Medicine, Duke University Medical Center, Durham, NC</wicri:regionArea><placeName><region type="state">Caroline du Nord</region></placeName></affiliation><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Clinical Research, Campbell University School of Pharmacy, Research Triangle Park, NC</wicri:regionArea><placeName><region type="state">Caroline du Nord</region></placeName></affiliation></author><author><name sortKey="Gheorghiade, Mihai" sort="Gheorghiade, Mihai" uniqKey="Gheorghiade M" first="Mihai" last="Gheorghiade">Mihai Gheorghiade</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL</wicri:regionArea><placeName><region type="state">Illinois</region></placeName></affiliation></author><author><name sortKey="Greenberg, Barry H" sort="Greenberg, Barry H" uniqKey="Greenberg B" first="Barry H." last="Greenberg">Barry H. Greenberg</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Medicine, USCD Medical Center, University of California, San Diego, CA</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="O Connor, Christopher M" sort="O Connor, Christopher M" uniqKey="O Connor C" first="Christopher M." last="O'Connor">Christopher M. O'Connor</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Cardiology, Duke University Medical Center/Duke Clinical Research Institute, Durham, NC</wicri:regionArea><placeName><region type="state">Caroline du Nord</region></placeName></affiliation></author><author><name sortKey="Nunez, Eduardo" sort="Nunez, Eduardo" uniqKey="Nunez E" first="Eduardo" last="Nunez">Eduardo Nunez</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>GlaxoSmithKline, Philadelphia, PA</wicri:regionArea><placeName><region type="state">Pennsylvanie</region></placeName></affiliation></author><author><name sortKey="Yancy, Clyde W" sort="Yancy, Clyde W" uniqKey="Yancy C" first="Clyde W." last="Yancy">Clyde W. Yancy</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Baylor University Medical Center, Dallas, TX</wicri:regionArea><placeName><region type="state">Texas</region></placeName></affiliation></author><author><name sortKey="Young, James B" sort="Young, James B" uniqKey="Young J" first="James B." last="Young">James B. Young</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Cardiovascular Medicine, Heart Failure Section, Cleveland Clinic Foundation, Cleveland, OH</wicri:regionArea><placeName><region type="state">Ohio</region></placeName></affiliation></author></analytic><monogr></monogr><series><title level="j">European Heart Journal</title><idno type="ISSN">0195-668X</idno><idno type="eISSN">1522-9645</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2008-08">2008-08</date><biblScope unit="volume">29</biblScope><biblScope unit="issue">16</biblScope><biblScope unit="page" from="1983">1983</biblScope><biblScope unit="page" to="1991">1991</biblScope></imprint><idno type="ISSN">0195-668X</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0195-668X</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract">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.</div></front></TEI><affiliations><list><country><li>États-Unis</li></country><region><li>Californie</li><li>Caroline du Nord</li><li>Illinois</li><li>Ohio</li><li>Pennsylvanie</li><li>Texas</li></region></list><tree><country name="États-Unis"><region name="Californie"><name sortKey="Fonarow, Gregg C" sort="Fonarow, Gregg C" uniqKey="Fonarow G" first="Gregg C." last="Fonarow">Gregg C. Fonarow</name></region><name sortKey="Abraham, William T" sort="Abraham, William T" uniqKey="Abraham W" first="William T." last="Abraham">William T. Abraham</name><name sortKey="Albert, Nancy M" sort="Albert, Nancy M" uniqKey="Albert N" first="Nancy M." last="Albert">Nancy M. Albert</name><name sortKey="Fonarow, Gregg C" sort="Fonarow, Gregg C" uniqKey="Fonarow G" first="Gregg C." last="Fonarow">Gregg C. Fonarow</name><name sortKey="Fonarow, Gregg C" sort="Fonarow, Gregg C" uniqKey="Fonarow G" first="Gregg C." last="Fonarow">Gregg C. Fonarow</name><name sortKey="Gheorghiade, Mihai" sort="Gheorghiade, Mihai" uniqKey="Gheorghiade M" first="Mihai" last="Gheorghiade">Mihai Gheorghiade</name><name sortKey="Greenberg, Barry H" sort="Greenberg, Barry H" uniqKey="Greenberg B" first="Barry H." last="Greenberg">Barry H. Greenberg</name><name sortKey="Nunez, Eduardo" sort="Nunez, Eduardo" uniqKey="Nunez E" first="Eduardo" last="Nunez">Eduardo Nunez</name><name sortKey="O Connor, Christopher M" sort="O Connor, Christopher M" uniqKey="O Connor C" first="Christopher M." last="O'Connor">Christopher M. O'Connor</name><name sortKey="Stough, Wendy Gattis" sort="Stough, Wendy Gattis" uniqKey="Stough W" first="Wendy Gattis" last="Stough">Wendy Gattis Stough</name><name sortKey="Stough, Wendy Gattis" sort="Stough, Wendy Gattis" uniqKey="Stough W" first="Wendy Gattis" last="Stough">Wendy Gattis Stough</name><name sortKey="Yancy, Clyde W" sort="Yancy, Clyde W" uniqKey="Yancy C" first="Clyde W." last="Yancy">Clyde W. Yancy</name><name sortKey="Young, James B" sort="Young, James B" uniqKey="Young J" first="James B." last="Young">James B. Young</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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