The Prognostic Impact of Smoking Status, Cessation, and Anticoagulation-Interaction on Adverse Outcomes in Patients with Atrial Fibrillation: A Systematic Review
Notice bibliographique
Résumé
Introduction: Atrial fibrillation (AF) and tobacco smoking represent two of the most significant and concurrent global health burdens. While smoking is an established risk factor for the development of incident AF, its prognostic impact following an AF diagnosis has remained controversial, particularly regarding thromboembolic risk (Zhu, Guo, & Hong, 2016). This systematic review synthesizes the evidence on the association between smoking status (current, former, and cessation) and a comprehensive range of adverse outcomes in patients with established AF. Methods: A systematic review was conducted adhering to PRISMA guidelines. The Cochrane Library, PubMed, and Embase databases were searched for observational studies (cohort or case-control) and meta-analyses evaluating the prognostic impact of smoking in patients with a confirmed AF diagnosis. Methodological quality and risk of bias for all included non-randomized studies were rigorously assessed using the 9-star Newcastle-Ottawa Scale (NOS) (Wells et al., 2000). Results: A total of 17 high-quality observational studies, including large national cohorts and one key meta-analysis, were included. The evidence was consistent and significant that persistent smoking is associated with increased all-cause mortality (Relative Risk 1.82, 95% CI 1.33–2.49) (Zhu, Guo, & Hong, 2016) and cardiovascular death (RR 1.54, 95% CI 1.31–1.81) (Zhu, Guo, & Hong, 2016). Smoking was also a significant predictor of major bleeding (RR 1.93, 95% CI 1.08–3.47) (Zhu, Guo, & Hong, 2016) and AF recurrence post-catheter ablation (RR 3.19, 95% CI 1.23–8.27) (Okutucu et al., 2010). The association with stroke was contradictory (the "stroke paradox"); a major meta-analysis found no significant link (RR 1.19, 95% CI 0.97–1.46) (Zhu, Guo, & Hong, 2016), while large cohort studies, particularly those in Vitamin K Antagonist (VKA)-treated populations, reported a significant risk (Adjusted Hazard Ratio 1.64–1.66) (Lee et al., 2021; Nakagawa et al., 2015). Critically, smoking cessation after AF diagnosis was associated with a rapid and significant risk reduction for ischemic stroke (aHR 0.702, 95% CI 0.595–0.827) and all-cause death (aHR 0.842, 95% CI 0.748–0.948) compared to persistent smokers (Lee et al., 2021). Discussion: The data confirm that persistent smoking is a major driver of mortality, major bleeding, and interventional failure in AF patients. The "stroke paradox" is likely not a true null effect but a signal of confounding, specifically an interaction with VKA (e.g., warfarin) therapy, where smoking is known to disrupt anticoagulation control (Nakagawa et al., 2015). This risk may be attenuated in the modern era of Direct Oral Anticoagulants (DOACs). Conclusion: Persistent smoking is unequivocally associated with a severe adverse prognostic profile in patients with AF. Smoking cessation provides a rapid, substantial, and quantifiable prognostic benefit—reducing stroke and mortality risk—and must be considered a critical, non-negotiable therapeutic intervention on par with anticoagulation and rhythm control.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,028 | 0,020 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».