Telomere length is independently associated with all-cause mortality in chronic heart failure

ObjectivePatients with heart failure have shorter mean leucocyte telomere length (LTL), a marker of biological age, compared with healthy subjects, but it is unclear whether this is of prognostic significance. We therefore sought to determine whether LTL is associated with outcomes in patients with heart failure.MethodsWe measured LTL in patients with heart failure from the BIOSTAT-CHF Index (n=2260) and BIOSTAT-CHF Tayside (n=1413) cohorts. Cox proportional hazards analyses were performed individually in each cohort and the estimates combined using meta-analysis. Our co-primary endpoints were all-cause mortality and heart failure hospitalisation.ResultsIn age-adjusted and sex-adjusted analyses, shorter LTL was associated with higher all-cause mortality in both cohorts individually and when combined (meta-analysis HR (per SD decrease in LTL)=1.16 (95% CI 1.08 to 1.24); p=2.66×10−5), an effect equivalent to that of being four years older. The association remained significant after adjustment for the BIOSTAT-CHF clinical risk score to account for known prognostic factors (HR=1.12 (95% CI 1.05 to 1.20); p=1.04×10−3). Shorter LTL was associated with both cardiovascular (HR=1.09 (95% CI 1.00 to 1.19); p=0.047) and non-cardiovascular deaths (HR=1.18 (95% CI 1.05 to 1.32); p=4.80×10−3). There was no association between LTL and heart failure hospitalisation (HR=0.99 (95% CI 0.92 to 1.07); p=0.855).ConclusionIn patients with heart failure, shorter mean LTL is independently associated with all-cause mortality.

Download Full-text

Prognostic Utility of the Braden Scale and the Morse Fall Scale in Hospitalized Patients With Heart Failure

Western Journal of Nursing Research ◽

10.1177/0193945916664077 ◽

2016 ◽

Vol 39 (4) ◽

pp. 507-523 ◽

Cited By ~ 3

Author(s):

Matthew Carazo ◽

Tina Sadarangani ◽

Sundar Natarajan ◽

Stuart D. Katz ◽

Caroline Blaum ◽

...

Keyword(s):

Heart Failure ◽

Primary Outcome ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Geriatric Syndromes ◽

Cox Proportional Hazards Models ◽

Braden Scale ◽

Patients With Heart Failure ◽

All Cause Mortality ◽

Prognostic Utility

Geriatric syndromes are common in hospitalized elders with heart failure (HF), but association with clinical outcomes is not well characterized. The purpose of this study ( N = 289) was to assess presence of geriatric syndromes using Joint Commission-mandated measures, the Braden Scale (BS) and Morse Fall Scale (MFS), and to explore prognostic utility in hospitalized HF patients. Data extracted from the electronic medical record included sociodemographics, medications, clinical data, comorbid conditions, and the BS and MFS. The primary outcome of mortality was assessed using Social Security Death Master File. Statistical analysis included Cox proportional hazards models to assess association between BS and MFS scores and all-cause mortality with adjustment for known clinical prognostic factors. Higher risk BS and MFS scores were common in hospitalized HF patients, but were not independent predictors of survival. Further study of the clinical utility of these scores and other measures of geriatric syndromes in HF is warranted.

Download Full-text

Predictors of hospitalizations for heart failure decompensation in patients with comorbid occupational chronic obstructive pulmonary disease

European Heart Journal ◽

10.1093/ehjci/ehaa946.0949 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

L.A Shpagina ◽

O.S Kotova ◽

I.S Shpagin ◽

G.V Kuznetsova ◽

N.V Kamneva ◽

...

Keyword(s):

Heart Failure ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Chronic Obstructive ◽

Length Of Service ◽

Obstructive Pulmonary Disease ◽

Copd Patients ◽

Patients With Heart Failure ◽

Occupational Copd ◽

Heart Failure Decompensation

Abstract Background Heart failure decompensation requiring hospitalization is an important event, associated with mortality and investigating its predictors is topical problem. Chronic obstructive pulmonary disease (COPD) is a common comorbidity for heart failure. Both conditions share common molecular mechanisms such as systemic inflammation. COPD is heterogeneous and subpopulations with different inflammation patterns may interact with heart failure in different manner. Airway inflammation in occupational COPD may differs from COPD in tobacco smokers. Additionally cardiotoxicity of industrial chemicals influence heart failure features. Despite this biological plausibility, heart failure and occupational COPD comorbidity is not studied enough. Purpose To reveal predictors of hospitalizations for heart failure decompensation in patients with heart failure and occupational COPD comorbidity. Methods Occupational COPD patients (n=115) were investigated in a prospective cohort observational study. Comparison group – 115 tobacco smokers with COPD. Control group – 115 healthy persons. Controls were selected by propensity score matching, covariates were COPD duration, age and gender. Then COPD groups were stratified according to heart failure. Working conditions, echocardiography, spirometry, pulsoxymetry, 6-mitute walking test were done. Molecular markers of tissue damage – chemokine ligand 18 (CCL 18), lactate dehydrogenase, cardiac troponin T, N-terminal pro-B-type natriuretic peptide (NT pro-BNP), protein S100 beta, von Willebrand factor were measured in serum by ELISA. Follow up after initial assessment was 12 month. Predictors were determined by Cox proportional hazards regression with ROC analysis. Results Heart failure rate in occupational COPD patients were higher – 54.8% versus 36.5% in tobacco smokers with COPD, p<0.05. Heart failure with preserved ejection fraction was predominant – 40.9%. Prevalence of biventricular heart failure was 38.3%, isolated right heart failure – 13%, left heart failure – 2.6%. Cumulative hospitalization rate in occupational COPD with heart failure group was higher than in comparison group, 17.5% and 9.5% respectively, p=0.01. In Cox proportional hazards regression model predictors of hospitalizations for heart failure decompensation during 12 months in this group were length of service (HR 1.22, 95% CI: 1.03–2.5), aromatic hydrocarbons concentration at workplaces air (HR 1.4, 95% CI: 1.15–1.96), serum protein S100 beta (HR 1.10, 95% CI: 1.02–1.87), SaO2 (HR 1.2, 95% CI: 1.06–2.13). Area under the ROC curve was 0.82. Conclusion Length of service, aromatic hydrocarbons concentration at workplaces air, serum protein S100 beta, SaO2 are considered to be independent risk factors of heart failure decompensation required hospitalization in patients with heart failure and occupational COPD comorbidity. Funding Acknowledgement Type of funding source: None

Download Full-text

Prediction of all-cause mortality with malnutrition assessed by controlling nutritional status score in patients with heart failure: a systematic review and meta-analysis

Public Health Nutrition ◽

10.1017/s1368980021002470 ◽

2021 ◽

pp. 1-8

Author(s):

Huiyang Li ◽

Peng Zhou ◽

Yikai Zhao ◽

Huaichun Ni ◽

Xinping Luo ◽

...

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Nutritional Status ◽

Meta Analysis ◽

Predictive Values ◽

Increased Risk ◽

Patients With Heart Failure ◽

All Cause Mortality ◽

Conut Score

Abstract Objective: The aim of this meta-analysis was to investigate the association between malnutrition assessed by the controlling nutritional status (CONUT) score and all-cause mortality in patients with heart failure. Design: Systematic review and meta-analysis. Settings: A comprehensively literature search of PubMed and Embase databases was performed until 30 November 2020. Studies reporting the utility of CONUT score in prediction of all-cause mortality among patients with heart failure were eligible. Patients with a CONUT score ≥2 are grouped as malnourished. Predictive values of the CONUT score were summarized by pooling the multivariable-adjusted risk ratios (RR) with 95 % CI for the malnourished v. normal nutritional status or per point CONUT score increase. Participants: Ten studies involving 5196 patients with heart failure. Results: Malnourished patients with heart failure conferred a higher risk of all-cause mortality (RR 1·92; 95 % CI 1·58, 2·34) compared with the normal nutritional status. Subgroup analysis showed the malnourished patients with heart failure had an increased risk of in-hospital mortality (RR 1·78; 95 % CI 1·29, 2·46) and follow-up mortality (RR 2·01; 95 % CI 1·58, 2·57). Moreover, per point increase in CONUT score significantly increased 16% risk of all-cause mortality during the follow-up. Conclusions: Malnutrition defined by the CONUT score is an independent predictor of all-cause mortality in patients with heart failure. Assessment of nutritional status using CONUT score would be helpful for improving risk stratification of heart failure.

Download Full-text

Abstract 3103: A Cardiopulmonary Exercise Testing Score for Predicting Risk in Patients with Heart Failure

Circulation ◽

10.1161/circ.116.suppl_16.ii_695-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Jonathan Myers ◽

Ross Arena ◽

Daniel Bensimhon ◽

Joshua Abella ◽

Leon Hsu ◽

...

Keyword(s):

Heart Failure ◽

Proportional Hazards ◽

Heart Rate Recovery ◽

Full Range ◽

Cardiopulmonary Exercise Testing ◽

Relative Weight ◽

Cox Proportional Hazards ◽

Cardiac Events ◽

Cardiopulmonary Exercise ◽

Patients With Heart Failure

Background. Cardiopulmonary exercise test (CPX) responses, including markers of ventilatory inefficiency (eg. the VE/VCO 2 slope and oxygen uptake efficiency slope [OUES]), and hemodynamic responses, such as heart rate recovery (HRR) and chronotropic incompetence (CRI) predict outcomes in patients with heart failure (HF). However, multivariate risk models integrating the full range of CPX variables have not been fully explored. Methods: 710 HF patients (568 male/142 female, mean age 56±13 years, EF 33±14%) underwent CPX and were followed for major cardiac events (death, transplant, LVAD implantation) for a mean of 29± 25 months. The age-adjusted prognostic power of peak VO 2 , VE/VCO 2 slope, OUES (VO 2 = a log 10 VE + b), resting end-tidal CO 2 pressure (PetCO 2 ), HRR, and CRI were determined using Cox proportional hazards, optimal cutpoints were determined, the variables were weighted, and a multivariate score was derived. Results. There were 111 composite outcomes. Multivariately, only CRI was not a significant predictor of risk. The VE/VCO 2 slope (≥ 34) was the strongest predictor, and was attributed a relative weight of 7, with weighted scores for abnormal HRR (≤6 beats at 1 min), OUES (>1.4), PetCO2 (<33mmHg), and peak VO 2 (≤14 ml/kg/min) having scores of 5, 3, 3, and 2, respectively. A Kaplan-Meier curve illustrating the incremental scores is presented in the figure ; a score >15 was associated with an annual mortality rate of 26% and a relative risk of 15. Conclusion . A score using CPX responses provides a simple and integrated method that powerfully predicts outcomes in patients with HF.

Download Full-text

Abstract 282: Impact of a Multi-Disciplinary Heart Failure Post-Discharge Management Clinic on Heart Failure Readmission Rates

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.6.suppl_1.a282 ◽

2013 ◽

Vol 6 (suppl_1) ◽

Author(s):

Cynthia Jackevicius ◽

Noelle de Leon ◽

Lingyun Lu ◽

Donald Chang ◽

Alberta Warner ◽

...

Keyword(s):

Heart Failure ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Control Group ◽

Post Discharge ◽

Readmission Rates ◽

All Cause Mortality ◽

Clinic Group

Background: Specialized heart failure (HF) clinics have demonstrated significant reduction in readmission rates. We evaluated a new multi-disciplinary HF clinic focused specifically on those recently discharged from a HF hospitalization. Methods: In this retrospective, cohort study, patients discharged with a primary HF diagnosis who attended the HF post-discharge clinic in 2010-11 were compared with historical controls from 2009. Within an average of six clinic visits, patients were seen by a physician assistant, a clinical pharmacist and a nurse case manager, with care overseen by an attending cardiologist. The clinic focused on identification of HF etiology and precipitating factors, medication titration to target doses, patient education, and medication adherence. The primary outcome was 90-day HF readmission, with secondary outcomes of mortality and a composite of 90-day HF readmission and mortality. A Cox proportional hazards model with adjustment for potentially confounding demographic and comorbidity variables was constructed to compare outcomes between groups. Results: Among the 277 patients (144 clinic and 133 control) in the study, 7.6% of patients in the clinic group and 23.3% of patients in the control group were readmitted for HF within 90 days (aHR 0.26; 95%CI=0.13-0.53 p = 0.0003;aRRR=74%; 95%CI= 47%-87%; ARR=15.7%;NNT=7). There were few deaths, but adjusted all-cause mortality was lower in the clinic group. For the composite of 90-day HF readmission and mortality, clinic patients had a lower risk (9.0% vs 28.6%; aHR 0.23; 95%CI=0.12-0.45; p<0.0001; aRRR=77%; 95%CI=55%-88%;ARR=19.6%;NNT=6). Conclusion: The multidisciplinary HF post-discharge clinic was associated with a significant reduction in 90-day HF readmission rates and all-cause mortality.

Download Full-text

Smokeless tobacco, snus, at admission for percutaneous coronary intervention and future risk for cardiac events

Open Heart ◽

10.1136/openhrt-2019-001109 ◽

2019 ◽

Vol 6 (2) ◽

pp. e001109

Author(s):

Ole Frobert ◽

Christian Reitan ◽

Dorothy K Hatsukami ◽

John Pernow ◽

Elmir Omerovic ◽

...

Keyword(s):

Heart Failure ◽

Percutaneous Coronary Intervention ◽

Smokeless Tobacco ◽

Proportional Hazards ◽

Coronary Intervention ◽

Cox Proportional Hazards ◽

P Value ◽

Cardiac Events ◽

Percutaneous Coronary ◽

All Cause Mortality

ObjectiveTo assess the risk of future death and cardiac events following percutaneous coronary intervention (PCI) in patients using smokeless tobacco, snus, compared with patients not using snus at admission for a first PCI.MethodsThe Swedish Coronary Angiography and Angioplasty Registry is a prospective registry on coronary diagnostic procedures and interventions. A total of 74 958 patients admitted for a first PCI were enrolled between 2009 and 2018, 6790 snus users and 68 168 not using snus. We used Cox proportional hazards regression for statistical modelling on imputed datasets as well as complete-case datasets.ResultsPatients using snus were younger (mean (SD) age 61.0 (±10.2) years) than patients not using snus (67.6 (±11.1), p<0.001) and more often male (95.4% vs 67.4%, p<0.001). After multivariable adjustment, snus use was not associated with the primary composite outcome of all-cause mortality, new coronary revascularisation or new hospitalisation for heart failure at 1 year (HR 0.98, 95% CI 0.91 to 1.05). In patients using snus at baseline who underwent a second PCI (n=1443), the duration from the index intervention was shorter for subjects who continued using snus (n=921, 63.8%) compared with subjects who had stopped (mean number of days 285 vs 406, p value=0.001).ConclusionsSnus use at admission for a first PCI was not associated with a higher occurrence of all-cause mortality, new revascularisation or heart failure hospitalisation. Discontinuing snus after a first PCI was associated with a significantly longer duration to a subsequent PCI.

Download Full-text

Association of statin use and clinical outcomes in heart failure patients: a systematic review and meta-analysis

Lipids in Health and Disease ◽

10.1186/s12944-019-1135-z ◽

2019 ◽

Vol 18 (1) ◽

Cited By ~ 2

Author(s):

Agata Bielecka-Dabrowa ◽

Ibadete Bytyçi ◽

Stephan Von Haehling ◽

Stefan Anker ◽

Jacek Jozwiak ◽

...

Keyword(s):

Heart Failure ◽

Clinical Outcomes ◽

Meta Analysis ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Patients With Heart Failure ◽

All Cause Mortality ◽

Meta Analyses ◽

Statin Use

Abstract Background The role of statins in patients with heart failure (HF) of different levels of left ventricular ejection fraction (LVEF) remains unclear especially in the light of the absence of prospective data from randomized controlled trials (RCTs) in non-ischemic HF, and taking into account potential statins’ prosarcopenic effects. We assessed the association of statin use with clinical outcomes in patients with HF. Methods We searched PubMed, EMBASE, Scopus, Google Scholar and Cochrane Central until August 2018 for RCTs and prospective cohorts comparing clinical outcomes with statin vs non-statin use in patients with HF at different LVEF levels. We followed the guidelines of the 2009 PRISMA statement for reporting and applied independent extraction by multiple observers. Meta-analyses of hazard ratios (HRs) of effects of statins on clinical outcomes used generic inverse variance method and random model effects. Clinical outcomes were all-cause mortality, cardiovascular (CV) mortality and CV hospitalization. Results Finally we included 17 studies (n = 88,100; 2 RCTs and 15 cohorts) comparing statin vs non-statin users (mean follow-up 36 months). Compared with non-statin use, statin use was associated with lower risk of all-cause mortality (HR 0.77, 95% confidence interval [CI], 0.72–0.83, P < 0.0001, I2 = 63%), CV mortality (HR 0.82, 95% CI: 0.76–0.88, P < 0.0001, I2 = 63%), and CV hospitalization (HR 0.78, 95% CI: 0.69–0.89, P = 0.0003, I2 = 36%). All-cause mortality was reduced on statin therapy in HF with both EF < 40% and ≥ 40% (HR: 0.77, 95% Cl: 0.68–0.86, P < 0.00001, and HR 0.75, 95% CI: 0.69–0.82, P < 0.00001, respectively). Similarly, CV mortality (HR 0.86, 95% CI: 0.79–0.93, P = 0.0003, and HR 0.83, 95% CI: 0.77–0.90, P < 0.00001, respectively), and CV hospitalizations (HR 0.80 95% CI: 0.64–0.99, P = 0.04 and HR 0.76 95% CI: 0.61–0.93, P = 0.009, respectively) were reduced in these EF subgroups. Significant effects on all clinical outcomes were also found in cohort studies’ analyses; the effect was also larger and significant for lipophilic than hydrophilic statins. Conclusions In conclusion, statins may have a beneficial effect on CV outcomes irrespective of HF etiology and LVEF level. Lipophilic statins seem to be much more favorable for patients with heart failure.

Download Full-text

Increased Plasma Concentrations of Soluble ST2 are Predictive for 1-Year Mortality in Patients with Acute Destabilized Heart Failure

Clinical Chemistry ◽

10.1373/clinchem.2007.096560 ◽

2008 ◽

Vol 54 (4) ◽

pp. 752-756 ◽

Cited By ~ 114

Author(s):

Thomas Mueller ◽

Benjamin Dieplinger ◽

Alfons Gegenhuber ◽

Werner Poelz ◽

Richard Pacher ◽

...

Keyword(s):

Heart Failure ◽

Plasma Concentration ◽

Proportional Hazards ◽

Interleukin 1 ◽

Tertiary Care ◽

Plasma Concentrations ◽

Cox Proportional Hazards ◽

Care Hospital ◽

Increased Risk ◽

All Cause Mortality

Abstract Background: The soluble isoform of the interleukin-1 receptor family member ST2 (sST2) has been implicated in heart failure. The aim of the present study was to evaluate the capability of sST2 as a prognostic marker in patients with acute destabilized heart failure. Methods: sST2 plasma concentrations were obtained in 137 patients with acute destabilized heart failure attending the emergency department of a tertiary care hospital. The endpoint was defined as all-cause mortality, and the study participants were followed up for 365 days. Results: Of the 137 patients enrolled, 41 died and 96 survived during follow-up. At baseline the median sST2 plasma concentration was significantly higher in the patients who died than in those who survived (870 vs 342 ng/L, P <0.001). Kaplan-Meier curve analyses demonstrated that the risk ratios for mortality were 2.45 (95% CI, 0.88–6.31; P = 0.086) and 6.63 (95% CI, 2.55–10.89; P <0.001) in the second tercile (sST2, 300–700 ng/L; 11 deaths vs 34 survivors) and third tercile (sST2, >700 ng/L; 25 deaths vs 21 survivors) of sST2 plasma concentrations compared with the first tercile (sST2, ≤300 ng/L; 5 deaths vs 41 survivors). In multivariable Cox proportional-hazards regression analyses, an sST2 plasma concentration in the upper tercile was a strong and independent predictor of all-cause mortality. Conclusions: Increased sST2 concentrations determined in plasma samples drawn from patients with acute destabilized heart failure at their initial presentation indicate increased risk of future mortality. Increased sST2 plasma concentrations are independently and strongly associated with one-year all-cause mortality in these patients.

Download Full-text

How Does HbA1c Predict Mortality and Readmission in Patients with Heart Failure? A Protocol for Systematic Review and Meta-analysis

10.21203/rs.3.rs-1064753/v1 ◽

2021 ◽

Author(s):

Junpeng Xu ◽

Ruixiang Zeng ◽

Xiaoyi Mai ◽

Wenjun Pan ◽

Yuzhuo Zhang ◽

...

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Predictive Value ◽

Meta Analysis ◽

Response Relationship ◽

Dose Response Relationship ◽

Patients With Heart Failure ◽

All Cause Mortality ◽

Patients With Diabetes ◽

Hba1c Levels

Abstract BackgroundAccumulating evidence suggests that HbA1c levels, a common clinical indicator of chronic glucose metabolism over the preceding 2-3 months, are independent risk factor for cardiovascular disease, including heart failure. The aim of this protocol is to conduct a systematic review and meta-analysis to assess the possible predictive value of HbA1c on mortality and readmission in patients with heart failure.MethodsA systematic and comprehensive search will be performed using PubMed, Embase, Central and other databases before August 2021 to identify relevant trials. All-cause mortality is the pre-specified primary endpoint. Cardiovascular death and heart failure readmission are secondary interested endpoints. We will only include prospective and retrospective cohort trials and place no restrictions on the language, race, region and publication period. The Newcastle-Ottawa Scale will be used to assess the quality of each trial included. If there are sufficient trials, we will conduct meta-analysis with pooled relative risks and corresponding 95% confidence interval to evaluate the possible predictive value of HbA1c on mortality and readmission. Otherwise, we will undertake a narrative synthesis. Heterogeneity and publication bias will be assessed. If heterogeneity is significant among included trails, a sensitivity analysis or subgroup analysis will be used to explore the source of heterogeneity, such as diverse types of heart failure or patients with diabetes and non-diabetes. Also, we will conduct meta-regression to examine the time-effect and treatment-effect modifiers on all-cause mortality compared between different quantile of HbA1c levels. Finally, a restricted cubic spline model may be used to explore the dose-response relationship between HbA1c and adverse outcomes.DiscussionThis planned analysis is anticipated to identify the predictive value of HbA1c on mortality and readmission in patients with heart failure. Improved understanding of different HbA1c levels and their specific effect on diverse types of heart failure or patients with diabetes and non-diabetes is expected to be figured out. Also, a dose-response relationship or optimal range of HbA1c will be determined to instruct clinicians and patients.PROSPERO registration detailsCRD42021276067

Download Full-text

Association of household secondhand smoke exposure and mortality risk in patients with heart failure

BMC Cardiovascular Disorders ◽

10.1186/s12872-019-1269-y ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Xin He ◽

Jingjing Zhao ◽

Jiangui He ◽

Yugang Dong ◽

Chen Liu

Keyword(s):

Heart Failure ◽

Mortality Risk ◽

Secondhand Smoke ◽

Proportional Hazards ◽

Univariate Analysis ◽

Cox Proportional Hazards ◽

Heart Failure Patients ◽

Cox Proportional Hazards Models ◽

Patients With Heart Failure ◽

Shs Exposure

Abstract Background Secondhand smoke (SHS) exposure is a well-established cardiovascular risk factor, yet association between SHS and prognosis of heart failure remains uncertain. Method Data were obtained from the US National Health and Nutrition Examination Surveys III from 1988 to 1994. Currently nonsmoking adults with a self-reported history of heart failure were included. Household SHS exposure was assessed by questionnaire. Participants were followed up through December 31, 2011. Cox proportional-hazards models were used to assess the association of household SHS exposure and mortality risk. Potential confounding factors were adjusted. Results Of 572 currently nonsmoking patients with heart failure, 88 were exposed to household SHS while 484 were not. There were totally 475 deaths during follow-up. In univariate analysis, household SHS was not associated with mortality risk (hazard ratio [HR]: 0.98, 95% confidence interval [CI]: 0.76–1.26, p = 0.864). However, after adjustment for demographic variables, socioeconomic variables and medication, heart failure patients in exposed group had a 43% increase of mortality risk compared with those in unexposed group (HR: 1.43, 95% CI: 1.10–1.86, p = 0.007). Analysis with further adjustment for general health status and comorbidities yielded similar result (HR: 1.47, 95% CI: 1.13–1.92, p = 0.005). Conclusion Household SHS exposure was associated with increased mortality risk in heart failure patients.

Download Full-text