***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The effect of smoking on survival in cancer patients is limited by the lack of structured prospect i ve assessment s of smoking at diagnosis . To assess the effect of smoking at diagnosis on survival , structured smoking assessment s were obtained in a cohort of 5,185 cancer patients within 30 days of a cancer diagnosis between 1982 and 1998 .  Hazard ratios ( HRs ) or odds ratios were generated to analyze the effects of smoking at diagnosis on overall mortality ( OM ) and disease‐specific mortality ( DSM ) in a patient cohort from 13 disease sites containing at least 100 patients in each disease site . With a minimum of 12 years of follow‐up , current smoking increased OM risk versus recent quit ( HR 1.17 ) , former ( HR 1.29 ) and never smokers ( HR 1.38 ) in the overall cohort . Current smoking increased DSM risk versus former ( HR 1.23 ) and never smokers ( HR 1.18 ) . In disease sites with proportionately large ( > 20 % ) recent quit cohorts ( lung and head/neck ) , current smoking increased OM and DSM risks as compared with recent quit . Current smoking increased mortality risks in lung , head/neck , prostate and leukemia in men and breast , ovary , uterus and melanoma in women . Current smoking was not associated with any survival benefit in any disease site . Data using prospect i ve structured smoking assessment s demonstrate that current smoking increased long‐term OM and DSM . St and ardized smoking assessment at diagnosis is an important variable for evaluating outcomes in cancer patients Abstract Objective : The aim of this study is to describe patients with heart failure and an ejection fraction ( EF ) of more than or equal to 40 % , managed in both Primary - and Hospital based outpatient clinics separately with their prognosis , comorbidities and risk factors . Further to compare the heart failure medication in the two groups . Design : We used the prospect i ve Swedish Heart Failure Registry to include 9654 out- patients who had HF and EF ≥40 % , 1802 patients were registered in primary care and 7852 in hospital care . Descriptive statistical tests were used to analyze base line characteristics in the two groups and multivariate logistic regression analysis to assess mortality rate in the groups separately . Setting : The prospect i ve Swedish Heart Failure Registry . Subjects : Patients with heart failure and an ejection fraction ( EF ) of more than or equal to 40 % . Main outcome measures : Comorbidities , risk factors and mortality . Results : Mean-age was 77.5 ( primary care ) and 70.3 years ( hospital care ) p < 0.0001 , 46.7 vs. 36.3 % women respectively ( p < 0.0001 ) and EF ≥50 % 26.1 vs. 13.4 % ( p < 0.0001 ) . Co-morbidities were common in both groups ( 97.2 % vs. 92.3 % ) , the primary care group having more atrial fibrillation , hypertension , ischemic heart disease and COPD . According to the multivariate logistic regression analysis smoking , COPD and diabetes were the most important independent risk factors in the primary care group and valvular disease in the hospital care group . All-cause mortality during mean follow-up of almost 4 years was 31.5 % in primary care and 27.8 % in hospital care . One year-mortality rates were 7.8 % , and 7.0 % respectively . Conclusion : Any co-morbidity was noted in 97 % of the HF- patients with an EF of more than or equal to 40 % managed at primary care based out-patient clinics and these patients had partly other independent risk factors than those patients managed in hospital care based out patients clinics . Our results indicate that more attention should be payed to manage COPD in the primary care group . KEY POINTS 97 % of heart failure patients with an ejection fraction of more than or equal to 40 % managed at primary care based out-patient clinics had any comorbidity . Patients in primary care had partly other independent risk factors than those in hospital care . All-cause mortality during mean follow-up of almost 4 years was higher in primary care compared to hospital care . In matched HF- patients  RAS-antagonists , beta-blockers as well as the combination of the two drugs were more seldom prescribed when managed in primary care compared with hospital care Objectives The goal of this study was to determine the relative contribution of major lifestyle factors on the development of  heart failure ( HF ) in older adults . Background HF incurs high morbidity , mortality , and health care costs among adults ≥65 years of age , which is the most rapidly growing segment of the U.S. population . Methods We prospect ively investigated separate and combined associations of lifestyle risk factors with  incident HF ( 1,380 cases ) over 21.5 years among 4,490 men and women in the Cardiovascular Health Study , which is a community-based cohort of older adults . Lifestyle factors included 4  dietary patterns ( Alternative Healthy Eating Index , Dietary Approaches to Stop Hypertension , an American Heart Association 2020 dietary goals score , and a Biologic pattern , which was constructed using previous knowledge of cardiovascular disease dietary risk factors ) , 4  physical activity metrics ( exercise intensity , walking pace , energy expended in leisure activity , and walking distance )  , alcohol intake ,  smoking , and  obesity  . Results No dietary pattern was associated with developing HF ( p > 0.05 ) . Walking pace and leisure activity were associated with a 26 % and 22 % lower risk of HF , respectively ( pace > 3 mph vs. < 2 mph ; hazard ratio [ HR ] : 0.74 ; 95 % confidence interval [ CI ] : 0.63 to 0.86 ; leisure activity ≥845 kcal/week vs. < 845 kcal/week ; HR : 0.78 ; 95 % CI : 0.69 to 0.87 ) . Modest alcohol intake , maintaining a body mass index < 30 kg/m2 , and not smoking were also independently associated with a lower risk of HF . Participants with ≥4 healthy lifestyle factors had a 45 % ( HR : 0.55 ; 95 % CI : 0.42 to 0.74 ) lower risk of HF . Heterogeneity by age , sex , cardiovascular disease , hypertension medication use , and diabetes was not observed . Conclusions Among older U.S. adults , physical activity , modest alcohol intake , avoiding obesity , and not smoking , but not dietary patterns , were associated with a lower risk of HF OBJECTIVES The goal of this study was to ascertain how continued cigarette smoking or smoking cessation related to long-term survival and morbidity in patients with established coronary artery disease managed with medical therapy or coronary bypass surgery .  BACKGROUND Although the association of cigarette smoking with coronary artery disease is well established , the morbidity and mortality associated with smoking behavior in patients with such disease receiving medical or surgical therapy are less well established . METHODS The 780 patients r and omized to medical therapy or coronary bypass surgery in the Coronary Artery Surgery Study ( CASS ) were subgrouped according to smoking behavior during a mean 11.2-year follow-up interval . Comparisons between smokers and nonsmokers were accomplished by univariate and Cox time-dependent multivariate analyses . RESULTS Survival at 10 years after entry into the study was 82 % among 468 patients who reported no smoking during follow-up ( nonsmokers ) compared with 77 % among the 312 smokers ( p = 0.025 ) . Survival was 80 % among those who smoked at entry but stopped ( quitters ) versus 69 % among those who continued smoking ( p = 0.025 ) . For patients who smoked at baseline and were r and omized to bypass surgery , survival at 10 years was 84 % among quitters and 68 % among nonquitters ( p = 0.018 ) ; the difference in survival between quitters ( 75 % ) and nonquitters ( 71 % ) was less among those r and omized to medical therapy ( p = NS ) . Among those who smoked at baseline , continued smoking increased the relative risk of death by 1.73 . After 10 years , smokers , in comparison with nonsmokers , were less likely to be angina free and more likely to be unemployed and had more activity limitation and more hospital admissions ( primarily for chest pain , heart attack , cardiac catheterization , peripheral vascular surgery and stroke ) . CONCLUSIONS Thus , among patients with documented coronary artery disease , continued cigarette smoking may result in decreased survival -- especially among those undergoing bypass surgery . Moreover , smokers have more angina , more unemployment , a greater limitation of physical activity and more hospital admissions Background —Cigarette smoking is a well-known risk factor for the development of cardiovascular disease , yet the mechanism of action involved is not completely understood . Because cigarette smoke contains superoxide and other reactive oxygen species , it has been hypothesized that some of the adverse effects of smoking may result from oxidative damage to endothelial cells , which results in nitric oxide ( NO ) shortage . However , little information is available regarding the acute effects of smoking on plasma concentrations of NO and antioxidants . We measured the changes in the combined plasma concentrations of nitrate and nitrite as an index of NO concentration , as well as changes in concentrations of major serum antioxidants ( ascorbic acid , cysteine , methionine , and uric acid ) in smokers after smoking a single cigarette .  Methods and Results —A r and omized crossover study of the effects of smoking a single cigarette was performed in 20 smokers . Smoking a sham cigarette induced no significant changes in all assayed parameters . However , smoking a single cigarette significantly decreased nitrate and nitrite plasma concentrations by 3.5±1.2 and 3.4±1.1 & mgr;mol/L , compared with plasma concentrations at presmoking and sham smoking , respectively . The concentrations of ascorbic acid and other antioxidants were also significantly lower after smoking a single cigarette . These parameters returned to preexperimental levels 60 minutes after smoking cessation . Conclusion —The present findings indicate that smoking a single cigarette temporarily decreases nitrate , nitrite , and serum antioxidant concentrations in the plasma . These transient changes may partially contribute to coronary vasoconstriction , which is routinely observed after smoking OBJECTIVES The aim of this study was to determine the value of serial B-type natriuretic peptide ( BNP ) assay for predicting post-discharge outcome of patients admitted for decompensated congestive heart failure ( CHF ) . BACKGROUND Patients hospitalized for decompensated CHF are frequently re-admitted . Thus , identification of high-risk patients before their discharge is a major issue that remains challenging . B-type natriuretic peptide measurement could be useful . METHODS  Serial BNP measurements  were performed from admission to discharge in two sample s of consecutive patients . Survivors were monitored for six months ; the main end point combined death or first re-admission for CHF . RESULTS Among the 105 survivors of the derivation study , all serial BNP values , percentage change in BNP levels , and predischarge Doppler mitral pattern correlated with the outcome . In contrast , clinical variables and left ventricular ejection fraction were poorly predictive . The predischarge BNP assay had the best discriminative power ( area under the receiver operating characteristic [ ROC ] curve = 0.80 ) and remained the lone significant variable in multivariate analysis ( hazard ratio [ HR ] = 1.14 [ 95 % confidence interval [ CI ] , 1.02 to 1.28 ] , p = 0.027 ) . Among the 97 survivors of the validation study , the predischarge BNP assay was also the most predictive parameter ( area under the ROC curve = 0.83 ) . The risk of death or re-admission increased in stepwise fashion across increasing predischarge BNP ranges ( p < 0.0001 ) . After adjustment for baseline covariables , the HRs were 5.1 [ 95 % CI 2.8 to 9.1 ] for BNP levels between 350 and 700 ng/l and 15.2 [ 95 % CI 8.5 to 27 ] for BNP levels > 700 ng/l , compared with BNP < 350 ng/l . CONCLUSIONS High predischarge BNP assay is a strong , independent marker of death or re-admission after decompensated CHF , more relevant than common clinical or echocardiographic parameters and more relevant than changes in BNP levels during acute cares Background Clinician-assigned New York Heart Association ( NYHA ) class is an established predictor of outcomes in heart failure . This study aims to test whether  patients ' self- assessment of functional status by NYHA class predicts hospital admissions , quality of life , and mortality . Methods and Results This was an observational study within a r and omized controlled trial . A total of 293 adult patients diagnosed with heart failure were recruited after an emergency admission at 3 acute hospitals in Norfolk , UK . Outcome measures included number of emergency admissions over 6 months , self-assessed quality of life measured with the Minnesota Living with Heart Failure question naire ( MLHFQ ) and EQ-5D at 6 months , and deaths up to 20 months ' follow-up . Patients were grouped into 3 NYHA groups ( I/II , III 
    Output:
    
Our review also found that persistent smoking was associated with poor health status , ventricular tachycardia , and arterial stiffness .