Abstract: Background　Smoking is an important risk factor in the development of heart failure with preserved ejection fraction（HFpEF），and previous studies have identified that smoking is a significant predictor of death in HFpEF population.However，the relationship between smoking and adverse events of heart failure has not been examined in patients with HFpEF.Objective　To analyze the relationship between smoking and adverse events of heart failure in patients with HFpEF.Methods　Patients with HFpEF diagnosed in Department of Cardiovascular Medicine and Department of General Practice of Central South University Xiangya School of Medicine Affiliated Haikou Hospital from 2013 to 2018 were selected as study subjects，and their baseline data，previous medical history and drug treatment data were collected.According to the smoking situation，all patients were divided into never smoking group，former smoker group，and current smoking group，and differences among the three groups were compared.Kaplan-Meier analysis was used to analyze the unadjusted cumulative incidence and survival probability of patients with heart failure requiring hospitalization，and the difference was compared using the Log-rank test.Multivariate Cox proportional hazard regression was used to analyze the risk of hospitalization for heart failure，death，and cardiac death among patients in three groups.Results　A total of 1 717 patients aged 58-87 with HFpEF were enrolled with an average age of（72.2±10.3）．There were 116 ( 6.7% ) current smoking，872 ( 50.8% ) former smoking，729 ( 42.5% ) never smoking. The median follow-up time was 2.9 years.And 387 patients ( 22.5% )  suffered from hospitalization for heart failure.There were 374 ( 21.8% )  deaths and 218 ( 12.7% ) cardiac deaths.There was a statistically significant difference in the unadjusted cumulative incidence and survival probability of hospitalization for heart failure among patients in three groups（Log-rank P=0.003，0.044）．Multivariate Cox proportional hazard regression analysis showed that current smoking was an influencing factor for hospitalization for heart failure〔HR=1.680，95%CI（1.083，2.606）〕，death〔HR=1.820，95%CI（1.195，2.773）〕，and cardiac death 〔HR=1.850，95%CI（1.092，3.133）〕in patients with HFpEF（P<0.005）．Conclusion　Current smoking is associated with an increased risk of adverse clinical outcomes for HFpEF，especially the hospitalization for heart failure.Smoking cessation strategies possibly have a role in reducing the risk of adverse cardiovascular outcomes in patients with HFpEF.

Key words: Heart failure, Smoking, Heart failure with preserved ejection fraction, Adverse events, Root cause analysis, Proportional hazards models

摘要： 背景　吸烟是发生射血分数保留的心力衰竭（HFpEF）的一个重要危险因素，既往研究证实吸烟是HFpEF患者死亡的一个重要预测因素。然而，在HFpEF患者中，吸烟与心力衰竭不良事件之间的关系尚未得到检验。目的　探讨吸烟与HFpEF患者心力衰竭不良事件之间的关系。方法　选取2013—2018年中南大学湘雅医学院附属海口医院心血管内科、全科医学科诊断的HFpEF患者为研究对象，收集其基线资料、既往病史、药物治疗数据等信息。根据吸烟状况分为目前吸烟、既往吸烟和从未吸烟三组，并比较三组之间的差异。采用Kaplan-Meier检验分析需要住院治疗的心力衰竭患者未校准的累积发病率、生存概率，并使用Log-rank检验比较差异，采用多因素Cox比例风险回归分析不同吸烟状况患者发生需要住院治疗的心力衰竭、死亡和心源性死亡风险。结果　最终入组1 717例HFpEF患者，年龄58~87岁，平均年龄（72.2±10.3）岁，目前吸烟116例（6.7%）、既往吸烟872例（50.8%）、从未吸烟729例（42.5%）。中位随访时间为2.9年，387例（22.5%）患者出现需要住院治疗的心力衰竭，374例（21.8%）死亡，218例（12.7%）心源性死亡。不同吸烟状况HFpEF患者需要住院治疗的心力衰竭未校准的累积发病率、生存概率比较，差异均有统计学意义（Log-rank P=0.003、0.044）。多因素Cox比例风险回归分析结果显示，目前吸烟是HFpEF患者发生需要住院治疗的心力衰竭〔HR=1.680，95%CI（1.083，2.606）〕、死亡〔HR=1.820，95%CI（1.195，2.773）〕、心源性死亡〔HR=1.850，95%CI（1.092，3.133）〕的影响因素（P<0.005）。结论　目前吸烟与HFpEF不良临床结局的风险增加有关，尤其是需要住院治疗的心力衰竭。戒烟策略可能有助于降低HFpEF患者心血管不良事件的风险。

关键词: 心力衰竭, 吸烟, 射血分数保留的心力衰竭, 不良事件, 影响因素分析, 比例危险度模型