Mental HealthHeart Patients Are Twice As Likely To Quit Smoking With Intensive In-Hospital Support
A new study in CMAJ (Canadian Medical Association Journal) shows that patients admitted to a hospital with coronary artery disease are twice as likely to quit smoking after receiving intensive smoking cessation support than those receiving minimal support.
The researchers, through a randomized clinical trial, compared intensive intervention with minimal intervention. They found that patients admitted for open heart surgery, such as coronary artery bypass grafts, had considerably higher long-term abstinence rates after one year, compared with those admitted for heart attacks, such as acute myocardial infarctions.
Other elements were instrumental in reaching successful long-term smoking cessation, including absence of a previous heart attack, postsecondary education and some type of smoking restrictions at home.
The study used an intervention that turned out to be in the highest rates of one-year confirmed smoking termination in prior tests in the US.
Education of periods of forty five to sixty minutes were used in this Canadian study, as well as counseling sessions in hospital followed by seven telephone counseling sessions with a nurse at precise intervals over two months. The patients found help in these calls in order to solve problems by developing cognitive, behavioral and social support strategies. They used those schemes when they found themselves in high-risk situations in order to go on with their smoke-free status.
Dr. Patricia Smith, of Northern Ontario School of Medicine and Dr. Ellen Burgess, of the University of Calgary write: "The rates of confirmed long-term abstinence rates observed in this trial are among the highest rates reported in cardiac populations and are among the highest reported absolute differences between minimal and intensive interventions."
The authors write: "Our results suggest that intensive counseling provided during the hospital stay is more effective than a stepped-care approach that provides intensive counseling only after a patient has relapsed."
They indicate that those inpatient programs have the potential to reduce considerably cardiac events, as well as hospital costs. They should develop into standard practice in hospitals.
In an associated note, Dr. Nancy Rigotti from Massachusetts General Hospital explains that these programs have not yet become standard care, despite many studies suggesting the possibilities of reducing overall cardiovascular illness and deaths with smoking cessation interventions. She points out that the major problem is that the intensive intervention model does not fit into the current health care delivery system. A principal challenge for the management of all chronic diseases, including tobacco, is maintaining health care from inpatient to outpatient status. She requests the progress of new innovative ways to shift the research findings into routine practice, a shift that she calls overdue.
"Smoking cessation initiated during hospital stay for patients with coronary artery disease: a randomized controlled trial"
Patricia M. Smith PhD, Ellen Burgess MD
DOI:10.1503/cmaj.080862
"Helping smokers with cardiac disease to abstain from
tobacco after a stay in hospital"
Nancy A. Rigotti MD
DOI:10.1503/cmaj.090729
cmaj
Written by Stephanie Brunner (B.A.)
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