US: Preventing secondhand smoke exposure for patients with heart failure
Even though avoiding secondhand smoke (SHS) exposure has been mostly addressed as a primary prevention strategy, it should also been seen as a secondary prevention tool...
Title: Secondhand smoke exposure and quality of life in patients with heart failure
Authors: S Weeks, S Glantz, T De Marco, A Rosen, K Fleischmann
Reference: Arch Intern Med. 2011; 171(21):1887-1893
http://bit.ly/GNTV1O
Reviewer: Joaquin Barnoya, MD, MPH
Reviewer comments: Even though avoiding secondhand smoke (SHS) exposure has been mostly addressed as a primary prevention strategy, it should also been seen as a secondary prevention tool. As this study shows, those with heart failure (HF) still exposed to SHS are more likely to have a lower quality of life compared to their unexposed counterparts. Furthermore, clinicians taking care of HF patients should advise them, and their care takers, to avoid SHS exposure as part of their treatment.
Purpose of study: To assess the relationship between SHS exposure with functional status and health-related quality of life (HRQOL) in patients with HF.
Location of study: California, US
Methods: Patients who self-reported as nonsmokers and with a clinical diagnosis of HF (regardless of ejection fraction) were enrolled from the cardiology and HF clinics at the University of California, San Francisco in a cohort study of SHS exposure on patients with HF. SHS was assessed by self-report, using a validated questionnaire and high-sensitivity assay for urinary cotinine level. The questionnaire included smoking history and SHS exposure at home, in the workplace, and in public places. Exposure was classified as hours per week. Individuals with high urinary cotinine levels (>50 ng/ml) were excluded as probable smokers resulting in a final sample of 202 patients. Multidimensional HRQOL was assessed with RAND 36-Item Short Form Health Survey and individual components were used to construct subscale scores in eight health-related domains. For each domain, the point scores range from 0 (worst) to 100(best). Age, sex, and other potential confounders were included in the analysis.
Results: Exposed patients were slightly younger, and just over half in both groups were men. Most patients had preserved ejection fraction and 41% had more significant systolic dysfunction. Twenty-three percent of unexposed individuals were in class I NYHA, 44% in class II, 29% in class III, and 5% in class IV. Corresponding percentages in exposed individuals were 15% in class I, 40% in class II, 36% in class III, and 9% in class IV. Almost one-quarter of the cohort reported SHS exposure, with most exposure at relatively low levels. Unadjusted analysis yield that self-reported SHS exposure was associated with lower mean HRQOL scores in each of the eight domains. Urinary cotinine quartile was a significant predictor of emotional well-being and role physical scores, with significant decrements of 3.18 and 4.50 points per quartile, respectively. Adjusted analysis yield that SHS exposure remained an independent predictor of emotional well-being, role physical, and role emotional subscales. Scores of exposed patients for emotional well-being were more than 10 points lower, role physical scores were almost 20 points lower, and role emotional score were more than 17 points lower than those of their unexposed counterparts. Using quartiles of urinary cotinine levels in adjusted analysis yield similar qualitative results.
Title: Secondhand smoke exposure and quality of life in patients with heart failure
Authors: S Weeks, S Glantz, T De Marco, A Rosen, K Fleischmann
Reference: Arch Intern Med. 2011; 171(21):1887-1893
http://bit.ly/GNTV1O
Reviewer: Joaquin Barnoya, MD, MPH
Reviewer comments: Even though avoiding secondhand smoke (SHS) exposure has been mostly addressed as a primary prevention strategy, it should also been seen as a secondary prevention tool. As this study shows, those with heart failure (HF) still exposed to SHS are more likely to have a lower quality of life compared to their unexposed counterparts. Furthermore, clinicians taking care of HF patients should advise them, and their care takers, to avoid SHS exposure as part of their treatment.
Purpose of study: To assess the relationship between SHS exposure with functional status and health-related quality of life (HRQOL) in patients with HF.
Location of study: California, US
Methods: Patients who self-reported as nonsmokers and with a clinical diagnosis of HF (regardless of ejection fraction) were enrolled from the cardiology and HF clinics at the University of California, San Francisco in a cohort study of SHS exposure on patients with HF. SHS was assessed by self-report, using a validated questionnaire and high-sensitivity assay for urinary cotinine level. The questionnaire included smoking history and SHS exposure at home, in the workplace, and in public places. Exposure was classified as hours per week. Individuals with high urinary cotinine levels (>50 ng/ml) were excluded as probable smokers resulting in a final sample of 202 patients. Multidimensional HRQOL was assessed with RAND 36-Item Short Form Health Survey and individual components were used to construct subscale scores in eight health-related domains. For each domain, the point scores range from 0 (worst) to 100(best). Age, sex, and other potential confounders were included in the analysis.
Results: Exposed patients were slightly younger, and just over half in both groups were men. Most patients had preserved ejection fraction and 41% had more significant systolic dysfunction. Twenty-three percent of unexposed individuals were in class I NYHA, 44% in class II, 29% in class III, and 5% in class IV. Corresponding percentages in exposed individuals were 15% in class I, 40% in class II, 36% in class III, and 9% in class IV. Almost one-quarter of the cohort reported SHS exposure, with most exposure at relatively low levels. Unadjusted analysis yield that self-reported SHS exposure was associated with lower mean HRQOL scores in each of the eight domains. Urinary cotinine quartile was a significant predictor of emotional well-being and role physical scores, with significant decrements of 3.18 and 4.50 points per quartile, respectively. Adjusted analysis yield that SHS exposure remained an independent predictor of emotional well-being, role physical, and role emotional subscales. Scores of exposed patients for emotional well-being were more than 10 points lower, role physical scores were almost 20 points lower, and role emotional score were more than 17 points lower than those of their unexposed counterparts. Using quartiles of urinary cotinine levels in adjusted analysis yield similar qualitative results.
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