Skip to main content
Journal cover image

Tobacco smoking in patients with heart failure and coronary artery disease: A 20-year experience at Duke University Medical Center.

Publication ,  Journal Article
Grubb, AF; Pumill, CA; Greene, SJ; Wu, A; Chiswell, K; Mentz, RJ
Published in: Am Heart J
December 2020

UNLABELLED: Smoking is associated with incident heart failure (HF), yet limited data are available exploring the association between smoking status and long-term outcomes in HF with reduced vs. preserved ejection fraction (i.e., HFrEF vs. HFpEF). METHODS: We performed a retrospective analysis of HF patients undergoing coronary angiography from 1990-2010. Patients with coronary artery disease (CAD) and HF were stratified by EF (< 50% vs. ≥50%), smoking status (prior/current vs. never smoker), and level of smoking (light/moderate vs. heavy). Time-from-catheterization-to-event was examined using Cox proportional hazard modeling for all-cause mortality (ACM), ACM/myocardial infarction/stroke (MACE), and ACM/HF hospitalization with testing for interaction by HF-type (HFrEF vs. HFpEF). RESULTS: Of 14,406 patients with CAD and HF, 85% (n = 12,326) had HFrEF and 15% (n = 2080) had HFpEF. At catheterization, 61% of HFrEF and 57% of HFpEF patients had a smoking history. After adjustment, there was a significant interaction between HF-type and the association between smoking status and MACE (interaction P = .009). Smoking history was associated with increased risk for MACE in patients with HFrEF (adjusted hazard ratio [HR] 1.18 [1.12-1.24]), but not HFpEF (HR 1.01 [0.90-1.12]). Active smokers had increased mortality following adjustment compared to former smokers regardless of HF-type (HFrEF HR 1.19 [1.06-1.32], HFpEF HR 1.30 [1.02-1.64], interaction P = .50). Heavy smokers trended towards increased risk of adverse outcomes versus light/moderate smokers; these findings were consistent across HF-type (interaction P > .12). CONCLUSION: Smoking history was independently associated with worse outcomes in HFrEF but not HFpEF. Regardless of HF-type, current smokers had higher risk than former smokers.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

December 2020

Volume

230

Start / End Page

25 / 34

Location

United States

Related Subject Headings

  • Universities
  • Tobacco Smoking
  • Time Factors
  • Stroke Volume
  • Stroke
  • Smokers
  • Retrospective Studies
  • Proportional Hazards Models
  • North Carolina
  • Non-Smokers
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Grubb, A. F., Pumill, C. A., Greene, S. J., Wu, A., Chiswell, K., & Mentz, R. J. (2020). Tobacco smoking in patients with heart failure and coronary artery disease: A 20-year experience at Duke University Medical Center. Am Heart J, 230, 25–34. https://doi.org/10.1016/j.ahj.2020.09.011
Grubb, Alex F., Christopher A. Pumill, Stephen J. Greene, Angie Wu, Karen Chiswell, and Robert J. Mentz. “Tobacco smoking in patients with heart failure and coronary artery disease: A 20-year experience at Duke University Medical Center.Am Heart J 230 (December 2020): 25–34. https://doi.org/10.1016/j.ahj.2020.09.011.
Grubb AF, Pumill CA, Greene SJ, Wu A, Chiswell K, Mentz RJ. Tobacco smoking in patients with heart failure and coronary artery disease: A 20-year experience at Duke University Medical Center. Am Heart J. 2020 Dec;230:25–34.
Grubb, Alex F., et al. “Tobacco smoking in patients with heart failure and coronary artery disease: A 20-year experience at Duke University Medical Center.Am Heart J, vol. 230, Dec. 2020, pp. 25–34. Pubmed, doi:10.1016/j.ahj.2020.09.011.
Grubb AF, Pumill CA, Greene SJ, Wu A, Chiswell K, Mentz RJ. Tobacco smoking in patients with heart failure and coronary artery disease: A 20-year experience at Duke University Medical Center. Am Heart J. 2020 Dec;230:25–34.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

December 2020

Volume

230

Start / End Page

25 / 34

Location

United States

Related Subject Headings

  • Universities
  • Tobacco Smoking
  • Time Factors
  • Stroke Volume
  • Stroke
  • Smokers
  • Retrospective Studies
  • Proportional Hazards Models
  • North Carolina
  • Non-Smokers