Abstract Body: Introduction:
Heart Failure (HF) patients have risk factors such as tobacco use, chronic kidney disease (CKD), and hypertension (HTN), all linked to poor cardiovascular outcomes. While CKD and DM are recognized as equivalent to atherosclerotic cardiovascular disease (ASCVD). HTN and tobacco use also pose significant cardiovascular risks. However, few studies have directly compared cardiovascular outcomes between HTN and tobacco use in HF patients.

Hypothesis:
This study compares all-cause mortality, ischemic heart disease (IHD), acute myocardial infarction (AMI), cerebrovascular accident (CVA), atherosclerosis, and peripheral vascular disease (PVD) in HF patients without CKD or DM, with either tobacco use or HTN.

Methods:
A retrospective cohort study was conducted using the TriNetX Collaborative Research Network from January 2007 to May 2025, including adults aged 18 years and older. After propensity score matching, two balanced cohorts were created, each with 31,914 HF patients without CKD or DM. Cohort 1 included patients with HTN but no tobacco use, CKD, or DM. Cohort 2 included those with tobacco use but no HTN, CKD, or DM. The mean age at index was 58 years; 57% were male and 38% female. Risk ratios (RR) and hazard ratios (HR) were calculated with 95% confidence intervals (CI) and p-values using the TriNetX platform.

Results:
All-cause mortality was slightly lower in cohort 1 (HTN) at 20.86% versus 21.70% in cohort 2 (tobacco), with a RR of 0.961 (95% CI: 0.933–0.990; p = 0.0095) and a HR of 0.586 (95% CI: 0.567–0.607; p < 0.0001). However, cohort 1 had significantly higher risks of IHD (47.13% vs. 33.41%; RR: 1.411; HR: 1.215; p < 0.0001), AMI (14.98% vs. 11.41%; RR: 1.313; HR: 1.001; p = 0.9549), CVA (9.52% vs. 4.16%; RR: 2.289; HR: 1.689; p = 0.0008), atherosclerosis (11.37% vs. 6.62%; RR: 1.719; HR: 1.167; p < 0.0001), and PVD (11.42% vs. 6.86%; RR: 1.665; HR: 1.198; p < 0.0001).

Conclusion:
While HF patients with hypertension had lower all-cause mortality compared to those with tobacco use, they experienced higher rates of cardiovascular events and mortality. These findings underscore the importance of both rigorous blood pressure management and tobacco cessation in this population.