Skip to main navigation menu Skip to main content Skip to site footer
##common.pageHeaderLogo.altText##

Original article

Vol. 152 No. 2930 (2022)

Long-term effects of systematic smoking cessation counselling during acute coronary syndrome, a multicentre before-after study

  • Lauriane Gilgien-Dénéréaz
  • Julian Jakob
  • Kali Tal
  • Baris Gencer
  • David Carballo
  • Lorenz Räber
  • Roland Klingenberg
  • Christian M. Matter
  • Isabella Sudano
  • Thomas F. Lüscher
  • Stephan Windecker
  • Olivier Muller
  • Stephane Fournier
  • Nicolas Rodondi
  • François Mach
  • Reto Auer
  • David Nanchen
DOI
https://doi.org/10.4414/SMW.2022.w30209
Cite this as:
Swiss Med Wkly. 2022;152:w30209
Published
18.07.2022

Summary

TRIAL DESIGN: In the Special Program University Medicine-Acute Coronary Syndromes (SPUM-ACS) observational study (clinical trial registration: NCT01000701), a multicentre before-after clinical trial, we assessed 5-year outcome after acute coronary syndrome, comparing a systematic with an opportunistic smoking cessation counselling phase.

METHODS: We studied smokers who were hospitalised for acute coronary syndromes (ACS), and we assessed self-reported smoking cessation, incidence of cardiovascular events and mortality 5 years after hospital discharge. In the observational phase, from August 2009 to October 2010, only smokers who requested smoking cessation counselling received it during hospitalisation. In the interventional phase, from November 2010 to February 2012, hospitalised smokers with ACS were systematically offered intensive smoking cessation counselling including four telephone calls within 2 months of discharge. Because of the before-after design, the care givers were aware of study phase. The objective was to assess whether systematic counselling to every smoker with ACS has an impact on the long-term smoking cessation rate, incidence of cardiovascular events and mortality. Missing data on smoking cessation were analysed with multiple imputation. The study was not powered to assess differences in 5-year smoking cessation rates or cardiovascular outcomes.

RESULTS: Overall, 458 smokers with ACS were included at baseline (225 during the intervention phase and 233 during the observation phase). At 5 years, 286 (62.4%) reported their smoking status (140 for the intervention phase and 146 for the observation phase) and 51 (11.1%) had died. There was no statistically significant difference in the abstinence rate between the interventional phase (75/140, 54%), and the observational phase (68/146, 47%), with a risk ratio with multiple imputation adjusted for age, sex, education and ACS type of 1.13 (95% confidence interval [CI] 0.84–1.51, p = 0.4). The 5-year risk of major acute cardiovascular event was similar in the intervention phase as compared with the observational phase. The multivariate adjusted hazard ratio for all-cause mortality was 0.84 (95% CI 0.45–1.60, p = 0.6). 

CONCLUSIONS: In this controlled long-term interventional study, systematic intensive smoking cessation counselling in all hospitalised smokers with ACS did not increase 5-year smoking cessation rates, nor decrease cardiovascular event recurrence, as compared with opportunistic smoking cessation counselling during hospitalization.

References

  1. Thun MJ, Carter BD, Feskanich D, Freedman ND, Prentice R, Lopez AD, et al. 50-year trends in smoking-related mortality in the United States. N Engl J Med. 2013 Jan;368(4):351–64. https://doi.org/10.1056/NEJMsa1211127
  2. Reid DD, Hamilton PJ, McCartney P, Rose G, Jarrett RJ, Keen H. Smoking and other risk factors for coronary heart-disease in British civil servants. Lancet. 1976 Nov;2(7993):979–84. https://doi.org/10.1016/S0140-6736(76)90830-8
  3. Yudi MB, Farouque O, Andrianopoulos N, Ajani AE, Kalten K, Brennan AL, et al.; Melbourne Interventional Group. The prognostic significance of smoking cessation after acute coronary syndromes: an observational, multicentre study from the Melbourne interventional group registry. BMJ Open. 2017 Oct;7(10):e016874. https://doi.org/10.1136/bmjopen-2017-016874
  4. Rea TD, Heckbert SR, Kaplan RC, Smith NL, Lemaitre RN, Psaty BM. Smoking status and risk for recurrent coronary events after myocardial infarction. Ann Intern Med. 2002 Sep;137(6):494–500. https://doi.org/10.7326/0003-4819-137-6-200209170-00009
  5. Dornelas EA, Sampson RA, Gray JF, Waters D, Thompson PD. A randomized controlled trial of smoking cessation counseling after myocardial infarction. Prev Med. 2000 Apr;30(4):261–8. https://doi.org/10.1006/pmed.2000.0644
  6. Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, et al. [2016 European Guidelines on cardiovascular disease prevention in clinical practice]. Kardiol Pol. 2016;74(9):821–936. https://doi.org/10.5603/KP.2016.0120
  7. Cabezas C, Advani M, Puente D, Rodriguez-Blanco T, Martin C ; ISTAPS Study Group. Effectiveness of a stepped primary care smoking cessation intervention: cluster randomized clinical trial (ISTAPS study). Addiction. 2011 Sep;106(9):1696–706. https://doi.org/10.1111/j.1360-0443.2011.03491.x
  8. Rigotti NA, Clair C, Munafò MR, Stead LF. Interventions for smoking cessation in hospitalised patients. Cochrane Database Syst Rev. 2012 May;(5):CD001837. https://doi.org/10.1002/14651858.CD001837.pub3
  9. Rovina N, Nikoloutsou I, Katsani G, Dima E, Fransis K, Roussos C, et al. Effectiveness of pharmacotherapy and behavioral interventions for smoking cessation in actual clinical practice. Ther Adv Respir Dis. 2009 Dec;3(6):279–87. https://doi.org/10.1177/1753465809350653
  10. Mohiuddin SM, Mooss AN, Hunter CB, Grollmes TL, Cloutier DA, Hilleman DE. Intensive smoking cessation intervention reduces mortality in high-risk smokers with cardiovascular disease. Chest. 2007 Feb;131(2):446–52. https://doi.org/10.1378/chest.06-1587
  11. Murray RL, Leonardi-Bee J, Marsh J, Jayes L, Li J, Parrott S, et al. Systematic identification and treatment of smokers by hospital based cessation practitioners in a secondary care setting: cluster randomised controlled trial. BMJ. 2013 Jul;347 jul08 1:f4004. https://doi.org/10.1136/bmj.f4004
  12. Auer R, Gencer B, Tango R, Nanchen D, Matter CM, Lüscher TF, et al. Uptake and efficacy of a systematic intensive smoking cessation intervention using motivational interviewing for smokers hospitalised for an acute coronary syndrome: a multicentre before-after study with parallel group comparisons. BMJ Open. 2016 Sep;6(9):e011520. https://doi.org/10.1136/bmjopen-2016-011520
  13. Nanchen D, Gencer B, Muller O, Auer R, Aghlmandi S, Heg D, et al. Prognosis of Patients With Familial Hypercholesterolemia After Acute Coronary Syndromes. Circulation. 2016 Sep;134(10):698–709. https://doi.org/10.1161/CIRCULATIONAHA.116.023007
  14. Gencer B, Montecucco F, Nanchen D, Carbone F, Klingenberg R, Vuilleumier N, et al. Prognostic value of PCSK9 levels in patients with acute coronary syndromes. Eur Heart J. 2016 Feb;37(6):546–53. https://doi.org/10.1093/eurheartj/ehv637
  15. Selby K, Nanchen D, Auer R, Gencer B, Räber L, Klingenberg R, et al. Low statin use in adults hospitalized with acute coronary syndrome. Prev Med. 2015 Aug;77:131–6. https://doi.org/10.1016/j.ypmed.2015.05.012
  16. Butty A, Gencer B, Koskinas KC, Carballo D, Räber L, Klingenberg R, et al. Control of cardiovascular risk factors and health behaviors in patients post acute coronary syndromes eligible for protein convertase subtilisin/kexin-9 inhibitors. Int J Cardiol. 2020 Jan;299:289–95. https://doi.org/10.1016/j.ijcard.2019.10.012
  17. White IR, Royston P, Wood AM. Multiple imputation using chained equations: issues and guidance for practice. Stat Med. 2011 Feb;30(4):377–99. https://doi.org/10.1002/sim.4067
  18. Anthonisen NR, Skeans MA, Wise RA, Manfreda J, Kanner RE, Connett JE ; Lung Health Study Research Group. The effects of a smoking cessation intervention on 14.5-year mortality: a randomized clinical trial. Ann Intern Med. 2005 Feb;142(4):233–9. https://doi.org/10.7326/0003-4819-142-4-200502150-00005
  19. Nohlert E, Öhrvik J, Tegelberg Å, Tillgren P, Helgason ÁR. Long-term follow-up of a high- and a low-intensity smoking cessation intervention in a dental setting—a randomized trial. BMC Public Health. 2013 Jun;13(1):592. https://doi.org/10.1186/1471-2458-13-592
  20. Lou P, Zhu Y, Chen P, Zhang P, Yu J, Zhang N, et al. Supporting smoking cessation in chronic obstructive pulmonary disease with behavioral intervention: a randomized controlled trial. BMC Fam Pract. 2013 Jun;14(1):91. https://doi.org/10.1186/1471-2296-14-91
  21. Connor Gorber S, Schofield-Hurwitz S, Hardt J, Levasseur G, Tremblay M. The accuracy of self-reported smoking: a systematic review of the relationship between self-reported and cotinine-assessed smoking status. Nicotine Tob Res. 2009 Jan;11(1):12–24. https://doi.org/10.1093/ntr/ntn010

Most read articles by the same author(s)

1 2 3 4 5 > >>