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Smoking Cessation After Admission to a Cardiac Unit

Am Fam Physician. 2004 Jun 1;69(11):2705.

An estimated 30 to 45 percent of patients are believed to spontaneously stop smoking after having a coronary event. Smoking cessation after myocardial infarction is associated with a 50 percent reduction in mortality beyond three to five years, and this reduction increases over time. Studies have shown that brief interventions with patients in coronary care units are not as effective in increasing smoking cessation rates as are longer interventions. However, studies of longer interventions have relied on patient self-reporting; only one study has attempted to verify smoking status biochemically. Quist-Paulsen and Gallefoss studied the impact of a smoking cessation program delivered by cardiac care nurses to patients in a Norwegian hospital's coronary care unit.

The patients were daily smokers and younger than 76 years of age who were being treated for myocardial infarction, unstable angina, or coronary artery bypass surgery. Patients with short life-expectancies because of other medical conditions were excluded from the study. Nurses recruited patients for the study two to four days after they were admitted and randomly allocated them to the intervention group or the control group (usual care).

All patients were offered group counseling sessions. The patients in the control group received no further specific instructions on how to stop smoking. In the intervention group, the nurses worked with each patient during the hospital stay, using a booklet and materials that stressed the risks of continued smoking and the improved outcomes associated with cessation. Patients were advised to stop smoking, and those with cravings were offered nicotine replacement. Spouses also were advised to stop smoking. The nurses telephoned each patient in the intervention group two days after discharge and again one week, three weeks, three months, and five months later to encourage cessation and deliver a fear arousal message based on the original program. Patients were seen in the clinic at six weeks and one year. Smoking status was confirmed by urine nicotine concentrations.

The 118 patients in the intervention group received one or two inpatient consultations and another one or two outpatient consultations, in addition to eight to nine telephone calls. The validated smoking cessation rates at one year were 57 percent in the intervention group and 37 percent in the control group. The number needed to treat was five to get one additional patient to stop smoking.

The authors conclude that a program based on fear arousal and relapse prevention and delivered by cardiac nurses is effective in enhancing smoking cessation rates in patients hospitalized for cardiac conditions.

Quist-Paulsen P, Gallefoss F. Randomised controlled trial of smoking cessation intervention after admission for coronary heart disease. BMJ. November 29, 2003;327:1254–7.


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