Chest
Volume 131, Issue 2, February 2007, Pages 446-452
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Original Research: Smoking Cessation
Intensive Smoking Cessation Intervention Reduces Mortality in High-Risk Smokers With Cardiovascular Disease

https://doi.org/10.1378/chest.06-1587Get rights and content

Abstract

Purpose:To compare an intensive smoking cessation intervention against usual care in hospitalized high-risk smokers with acute cardiovascular disease.

Methods:A total of 209 hospitalized smokers were randomized to the intensive intervention (n = 109) or to usual care (n = 100). Usual care consisted only of counseling and printed educational material provided prior to hospital discharge. Intensive treatment consisted of a minimum of 12 weeks of behavior modification counseling and individualized pharmacotherapy provided at no cost to the participant. Smoking status in all subjects was confirmed biochemically (ie, by measuring expired carbon monoxide) at 3, 6, 12, and 24 months after randomization. Outcomes included point prevalence and continuous abstinence smoking cessation rates, hospitalizations, and all-cause mortality.

Results:At each follow-up interval, point prevalence and continuous abstinence smoking cessation rates were significantly greater in the intensive-treatment group compared to the usual-care group. At 24 months, continuous abstinence smoking cessation rates were 33% in the intensive-treatment group and 9% in the usual-care group (p < 0.0001). Over the 2-year follow-up period, 41 patients in the usual-care group were hospitalized compared to 25 patients in the intensive-treatment group (relative risk reduction [RRR], 44%; 95% confidence interval [CI], 16 to 63%; p = 0.007). The all-cause mortality rate was 2.8% in the intensive-treatment group and 12.0% in the usual-care group (RRR, 77%; 95% CI, 27 to 93%; p = 0.014). The absolute risk reduction in mortality was 9.2% with a number needed to treat of 11.

Conclusion:Hospitalized smokers, especially those with cardiovascular disease, should undergo treatment with a structured intensive cessation intervention. The duration of the initial treatment should be 3 months.

Section snippets

Patients

Patients aged 30 to 75 years who were admitted to the coronary care unit at our university-affiliated teaching hospital with a diagnosis of acute coronary syndrome or decompensated heart failure were considered for participation in the study. Daily smokers who had smoked for a minimum of 5 years with a Fagerstrom score of > 7 were eligible to participate.19Smokers were excluded if they did not speak and read the English language. Patients with current alcohol or illicit substance addiction were

Results

During the enrollment period from January 2001 though December 2002, approximately 425 patients who were self-identified current smokers and had acute coronary syndrome or decompensated heart failure were admitted to our coronary care unit. Of these, 330 patients met the inclusion/exclusion criteria. These patients were approached concerning participation in the study. Of these, 209 patients agreed to participate in the trial.

A total of 109 smokers were randomized to receive the intensive

Discussion

The results of our study demonstrate that an intensive smoking cessation intervention in high-risk smokers with cardiovascular disease is not only effective in achieving smoking cessation, but also reduces hospitalizations and total mortality. This study is the first to demonstrate the effectiveness of a structured smoking cessation intervention in high-risk smokers with cardiovascular disease that not only leads to a reduction in smoking but also to an improvement in the rate of occurrence of

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The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

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