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The impact of smoking on third-degree atrioventricular block outcomes: A propensity-matched analysis
Mirza Faris Ali Baig1, Kalyan Chaliki2
1Asante Three Rivers Medical Center, 500 SW Ramsey Avenue, Grants Pass, OR, USA, 97527.
Insights
Patients with third-degree atrioventricular (AV) block and a history of smoking experienced lower in-hospital mortality and costs. This study analyzed 5,560 matched patients, finding smokers had better outcomes, including reduced cardiogenic shock and shorter hospital stays.
Area of Science:
- Cardiology
- Epidemiology
- Public Health
Background:
- Third-degree atrioventricular (AV) block is a rare but serious condition requiring immediate intervention, often attributed to coronary artery disease (CAD).
- Smoking is a major risk factor for CAD, yet its direct impact on third-degree AV block outcomes is not well-documented.
Purpose of the Study:
- To investigate the association between smoking history and clinical outcomes in patients diagnosed with third-degree AV block.
- To analyze in-hospital mortality, complication rates, and healthcare resource utilization in relation to smoking status.
Main Methods:
- A retrospective cohort study utilized the National Inpatient Sample (NIS) database from 2019-2020.
- Included adult admissions with a primary diagnosis of third-degree AV block and a history of smoking.
- Analyzed outcomes including mortality, cardiogenic shock, cardiac arrest, length of stay (LOS), and hospitalization costs, using multivariable regression and propensity score matching.
Main Results:
- The study included 77,650 admissions, with 29,380 (37.8%) patients identified as smokers.
- After propensity score matching (5,560 patients), smokers showed significantly decreased odds of in-hospital mortality (aOR, 0.59; CI, 0.44-0.78).
- Smokers also experienced reduced rates of cardiogenic shock, cardiac arrest, tracheal intubation, mechanical ventilation, shorter LOS, and lower total hospitalization costs.
Conclusions:
- Third-degree AV block patients with a smoking history demonstrated better in-hospital outcomes compared to non-smokers.
- These outcomes include lower mortality, fewer severe complications like cardiogenic shock and cardiac arrest, and reduced healthcare resource utilization.
Background:
Third-degree atrioventricular (AV) blocks are rare but cause significant symptoms and require immediate intervention. Coronary artery disease (CAD) is felt to be the most common etiology. Although smoking is a prominent risk factor for CAD, there is a paucity of data assessing the direct effect of smoking on third-degree AV block.
Methods:
We performed a retrospective cohort study on adult-weighted admissions in 2019-2020 with a primary diagnosis of third-degree AV block and a history of smoking using the National Inpatient Sample (NIS) database. In-hospital mortality, rates of pacemaker insertion, cardiogenic shock, cardiac arrest, acute kidney injury (AKI), stroke, tracheal intubation, mechanical ventilation, mechanical circulatory support, vasopressor use, length of stay (LOS), and total hospitalization costs were analyzed using regression analysis. We performed a secondary analysis using propensity score matching to confirm the results.
Results:
A total of 77,650 admissions met inclusion criteria (33,625 females [43.3 %], 58,315. Caucasians [75 %], 7030 African American [9 %], 6155 Hispanic [7.9 %]; mean [SD] age 75.4.[10.2] years) before propensity matching. A total of 29,380 (37.8 %) patients with AV block were smokers.A total of 5560 patients with and without a history of smoking were matched for the analysis. Smokers had.decreased odds of mortality (aOR, 0.59; CI, 0.44-0.78; p < 0.001), cardiogenic shock, cardiac arrest, tracheal intubation, mechanical ventilation, shorter LOS, and lower total hospital costs in both the multivariable regression and propensity-matched analyses.
Conclusion:
Third-degree AV block had lower in-hospital mortality, cardiogenic shock, cardiac arrest, LOS, and total hospitalization cost in patients with smoking history.
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