Mortality, Major Thromboembolic Events, and Major Adverse Cardiovascular Outcomes in Patients with Various Smoking Histories Diagnosed with COVID-19

Principal Investigator: Gregory Piazza, M.D., M.S.

Authors: Anthony M. Tristani, Candrika Dini Khairani, M.D., M.MSc., Briana M. Barns, B.S., B.A., Samuel Z. Goldhaber, M.D., Gregory Piazza, M.D., M.S.
Lay Abstract

A history of smoking can elevate one’s risk of contracting respiratory infections. Because COVID-19 often causes respiratory symptoms with pneumonia, we examined whether a patient’s prior smoking history can impact the likelihood of death, major cardiovascular disease, or development of blood clots in patients hospitalized with COVID-19. We analyzed the medical records of 399 patients in the Mass General Brigham network who were hospitalized for COVID-19 and compared the frequencies of these negative outcomes between patients with and without any smoking history. Our patient cohort included about one-third females and one-third non-white patients. Those with a smoking history were on average approximately 12 years older than those without. The likelihood of cardiovascular complications or blood clots with COVID is similar regardless of one’s smoking history. We believe that this evidence will inspire further research to prevent death or medical disability in patients with a past smoking history who are hospitalized with COVID-19.

Scientific Abstract

Introduction:
Smoking history increases the risk of negative health outcomes, including respiratory infections. COVID-19 causes respiratory symptoms, which may be aggravated in patients with smoking history.

Objective:
We examined mortality, major thromboembolic outcomes, and major adverse cardiovascular events in patients with and without a history of smoking who tested positive for COVID-19.

Methods:
Of 399 patients hospitalized with COVID-19 in the Mass General Brigham system, we assessed 162 patients with smoking history and 237 patients without. We compared the rates of death and adjudicated major thromboembolic and cardiovascular events in this cohort.

Results:
Patients with smoking history were 35.8% female and 33.95% non-white. Their mean age was 66.97 years compared to 57.2 years in patients without (P<0.001). Mortality rates in patients with smoking history were 21.38% compared to 8.90% in patients without (P<0.001). Frequencies of major thromboembolic or cardiovascular events were similar regardless of smoking history (18.52% and 27.16% vs. 15.19% and 20.25%, respectively, P=0.380).

Discussions:
Despite a significant correlation between smoking history and mortality in patients with COVID-19, we observed similar rates of major thromboembolic and cardiovascular events in both groups. Continued investigation is warranted in patients with smoking history to determine how to prevent COVID-19 related mortality.

Clinical Implications
We believe that this finding will inspire physicians and researchers to launch further initiatives to lower the prevalence of smoking, especially in patients with underlying comorbidities or risk factors that make them more susceptible to contracting COVID-19.

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