A smoker's paradox in patients hospitalized for heart failure: findings from OPTIMIZE-HF
Key result
Current or recent smoking was associated with lower adjusted in-hospital mortality compared with non-smoking in patients hospitalized for heart failure (OR 0.70; 95% CI 0.56-0.88; P=0.002).
Why the study?
Does current/recent smoking reduce in-hospital mortality in patients hospitalized with heart failure?
Population
48,612 patients hospitalized with heart failure (HF) from 259 hospitals
Comparison
Current/recent smoking vs No current/recent smoking
Design
Cohort
Follow-up
In-hospital and early post-discharge
Authors
Discussion
Loading...
Member takes
Implication
Should not change smoking cessation advice in heart failure; leaves open whether the association reflects confounding.
Study Design
Type
Cohort (n=48,612)
Multicenter
Yes
Structured PICO
Does current/recent smoking reduce in-hospital mortality in patients hospitalized with heart failure?
P
Population
48,612 patients hospitalized with heart failure across 259 hospitals, comparing outcomes between current/recent smokers and non-smokers.
E
Exposure
Current/recent smoking
C
Comparator
No current/recent smoking
O
Outcome
In-hospital mortalityhard clinical
Main Result
Odds Ratio: 0.7 (95% CI 0.56–0.88)
Absolute Event Rate: 2.3% vs 3.9%
p-value: p=0.002
Current or recent smoking is paradoxically associated with lower in-hospital mortality in patients hospitalized for heart failure, an effect not fully explained by measured covariates.
Limitations
- The residual association of smoking and better prognosis was not fully explained by measured covariates, suggesting potential unmeasured confounding.
Cite This Study
Fonarow et al. (2008) conducted a cohort in Heart failure (n=48,612). Current or recent smoking vs. No current or recent smoking was evaluated on In-hospital mortality (OR 0.70, 95% CI 0.56-0.88, p=0.002). Current or recent smoking was associated with lower adjusted in-hospital mortality compared with non-smoking in patients hospitalized for heart failure (OR 0.70; 95% CI 0.56-0.88; P=0.002).