Abstract 17932: Smoking History is Associated With Worse Outcomes in Patients With Sarcopenia Admitted for Acute Decompensated Heart Failure

Abstract

Background: Sarcopenia and smoking are independently associated with worse heart failure (HF) outcomes; therefore, their combined effect is likely even more detrimental. Research Questions: We studied the impact of sarcopenia and smoking on outcomes in patients admitted for acute decompensated HF (ADHF). Methods: We conducted a retrospective cohort study of 406 consecutive patients hospitalized at our tertiary care center for ADHF from 2017 to 2020 with computed tomography of the chest one month before the discharge date. Semi-automatic measurements were made at T12 (Figure 1A) and adjusted for height squared to obtain skeletal muscle index (SMI). To compare survival, patients were divided into four groups: nonsarcopenic nonsmokers (controls, 22.4%), sarcopenic nonsmokers (10.6%), nonsarcopenic smokers (44.3%), and sarcopenic smokers (22.7%). Sarcopenia was the lowest sex-stratified SMI tertile (cutoffs of 29.6 cm 2 /m 2 in males and 25.7 cm 2 /m 2 in females), and smokers were those who had ever smoked. Results: The mean admission age of our cohort was 70±14 years, 44.3% were female, and 67.0% had a smoking history (191 former and 81 active). Compared to nonsmokers, patients with a smoking history had more COPD (53.3% vs. 18.7%, p<0.001) and higher all-cause mortality (HR 1.41, 95%CI 1.05-1.90, p=0.021), but did not differ in SMI. When further stratified by sarcopenia, during a median 22.9 (3.0-33.5) months of follow-up, all groups had higher all-cause mortality when compared to controls (figure 1B); the highest rate was seen in sarcopenic smokers, which remained significant when adjusted for age, male sex, Caucasian race, CAD, and COPD (HR 1.71, 95%CI 1.12-2.60, p=0.013). Sarcopenic smokers also had the highest rate of ICU admissions (50.0%). Conclusions: Sarcopenia and smoking portend worse prognoses in patients admitted for ADHF, with sarcopenic smokers having the worst outcomes, independent of COPD history.