Demystifying Smoker's Paradox: A Propensity Score–Weighted Analysis in Patients Hospitalized With Acute Heart Failure
<h3>Background</h3><p dir="ltr">Smoker's paradox has been observed with several vascular disorders, yet there are limited data in patients with acute heart failure ( HF ). We examined the effects of smoking in patients with acute HF using data from a large multicente...
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| مؤلفون آخرون: | , , , , , , , , , , , , , , , , , , |
| منشور في: |
2019
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| الموضوعات: | |
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إضافة وسم
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| الملخص: | <h3>Background</h3><p dir="ltr">Smoker's paradox has been observed with several vascular disorders, yet there are limited data in patients with acute heart failure ( HF ). We examined the effects of smoking in patients with acute HF using data from a large multicenter registry. The objective was to determine if the design and analytic approach could explain the smoker's paradox in acute HF mortality.</p><h3>Methods and Results</h3><p dir="ltr">The data were sourced from the acute HF registry (Gulf CARE [Gulf Acute Heart Failure Registry]), a multicenter registry that recruited patients over 10 months admitted with a diagnosis of acute HF from 47 hospitals in 7 Middle Eastern countries. The association between smoking and mortality (in hospital) was examined using covariate adjustment, making use of mortality risk factors. A parallel analysis was performed using covariate balancing through propensity scores. Of 5005 patients hospitalized with acute HF , 1103 (22%) were current smokers. The in‐hospital mortality rates were significantly lower in current smoker's before (odds ratio, 0.71; 95% CI , 0.52–0.96) and more so after (odds ratio, 0.47; 95% CI , 0.31–0.70) covariate adjustment. With the propensity score–derived covariate balance, the smoking effect became much less certain (odds ratio, 0.63; 95% CI, 0.36–1.11).</p><h3>Conclusions</h3><p dir="ltr">The current study illustrates the fact that the smoker's paradox is likely to be a result of residual confounding as covariate adjustment may not resolve this if there are many competing prognostic confounders. In this situation, propensity score methods for covariate balancing seem preferable.</p><h3>Clinical Trial Registration</h3><p dir="ltr">URL : https://www.clinicaltrials.gov/ . Unique identifier: NCT 01467973.</p><h2>Other Information</h2><p dir="ltr">Published in: Journal of the American Heart Association<br>License: <a href="https://creativecommons.org/licenses/by/4.0/" target="_blank">https://creativecommons.org/licenses/by/4.0/</a><br>See article on publisher's website: <a href="https://dx.doi.org/10.1161/jaha.119.013056" target="_blank">https://dx.doi.org/10.1161/jaha.119.013056</a></p> |
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