Investigating the Smoker's Paradox: Congested Heart Failure Outcomes in Smokers

Abstract

BackgroundSmoking is a well-established risk factor for cardiovascular diseases, negatively impacting overall health and decreasing life expectancy. Intriguingly, the smoker's paradox suggests that current smokers diagnosed with congestive heart failure (CHF) may experience lower short-term mortality rates than their non-smoking counterparts. In this study, we investigate the effects of smoking on in-hospital outcomes for CHF patients in the United States, aiming to explore the presence and implications of this paradox within this population. MethodsIn this study, we analyzed data from the 2020 National Inpatient Sample (NIS) to identify patients admitted primarily for congestive heart failure (CHF). We then focused on patients with ICD-10 codes indicative of smoking or tobacco use. To investigate the associations, we utilized logistic and linear regression analyses, adjusting for potential confounders. Results with a 2-tailed p-value of 0.05 or lower were deemed statistically significant. ResultsIn 2020, a total of 513,730 hospitalizations were recorded for congestive heart failure (CHF). Among these cases, 247,575 (48.2%) involved patients with a secondary diagnosis of smoking history or use. After adjusting for factors such as age, race, gender, hospital bed size, location, teaching status, insurance coverage, income level, and Elixhauser comorbidities, CHF patients with a secondary smoking diagnosis demonstrated lower rates of in-hospital mortality (aOR 0.55, 95% CI 0.51-0.62), vasopressor initiation (aOR 0.56, 95% CI 0.48-0.65), mechanical circulatory support (aOR 0.33, 95% CI 0.24-0.44), and hemodialysis initiation (aOR 0.44, 95% CI 0.37-0.52). ConclusionOur study revealed that CHF patients with a smoking history exhibited lower odds of in-hospital mortality, vasopressor use, mechanical circulatory support, and hemodialysis initiation in comparison to non-smokers. To gain a comprehensive understanding of the smoker's paradox, it is essential to conduct more extensive, robust investigations that uncover the underlying mechanisms, ultimately informing the development of more effective patient care strategies.