Linda Jones1; Bo Liu1; Mustafa I Ahmed1; Marjan Mujib1; Olaniyi J Ekundayo1; Michel White2; Wilbert S Aranow3; Ali Ahmed4
　　1 Univ of Alabama at Birmingham， Birmingham， AL
　　2 Montreal Heart Institute， Montreal， Canada
　　3 New York Med College， New York， NY
　　4 Univ of Alabama at Birmingham， Birmingham， AL
　　Background: Smoking is associated with increased risk of atrial fibrillation (AF). However， little is known about the effect of smoking on outcomes in AF. We used the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) data to test the hypothesis that smoking is associated with poor outcomes in AF patients 65 years.
　　Methods: Of the 4060 AFFIRM patients with recurrent AF and without contraindication to anticoagulation， 3091 (76%) were 65 years， of whom 276 (9%) reported smoking during the past 2 years. Propensity scores for smoking， calculated for each patient， were used to assemble a cohort of 254 and 743 (1:3 match) smokers and non-smokers respectively， who were balanced on 55 baseline characteristics. Matched Cox regression models were used to estimate the association between smoking and outcomes during 3.5 years of mean follow-up.
　　Results: All-cause mortality occurred in 27% (rate， 8273/10000 person-years) and 17% (rate， 4935/10000 person-years) of matched smokers and non-smokers respectively (matched hazard ratio when smoking was compared with no smoking， 1.78; 95% confidence interval {CI}， 1.28 –2.46; P=0.001). Pre-match (n=3091) unadjusted， multivariable-adjusted， and propensity-adjusted hazard ratios for all-cause mortality associated with smoking were 1.64 (95% CI， 1.29 –2.09; P<0.0001)， 1.62 (95% CI， 1.26 –2.08; P<0.0001)， and 1.54 (95% CI， 1.19 –1.98; P<0.001). All-cause hospitalization occurred in 67% and 62% of matched smokers and non-smokers respectively (matched hazard ratio when smoking was compared with no smoking， 1.26; 95% CI， 1.00 –1.59; P=0.047). Smoking had no association with ischemic stroke， which occurred in 3% of patients in each matched group.
　　Conclusion: Smoking is associated with a significant and independent increase in the risk of death and hospitalization in older adults with AF. To the best of our knowledge this is the first report of the effect of smoking on outcomes in elderly AF patients. These findings underscore the deleterious effects of smoking and highlight the importance of smoking cessation in older adults with AF.