[Comprehensive treatment of nicotine dependence in patients with cardiovascular diseases--personal experience]

To evaluate psychological factors influencing the effectiveness of smoking cessation using bupropion and psychological intervention in patients with cardiovascular diseases.

A group of 59 patients (26 M, 33 F; mean age 44.2 +/- 10.2 years) identified among smokers admitted to the 1st Cardiac Department between 2000 and 2001 with hypertension (n = 46) and coronary artery disease (n = 13). Entry criteria to participate in a 7-week programme included nicotine dependence and no contraindications to bupropion. Pharmacotherapy was used in parallel with psychological interventions based upon cognitive and behavioural methods. The type and degree of nicotine dependence was measured using Fragerstrom tolerance questionnaire whereas motivation was scored according to the Schneider questionnaire. The severity of depression symptoms was measured by the Beck Depression Inventory.

At 2 months and at one year after discontinuation of treatment 74.6% and 40% of the patients respectively maintained abstinence from smoking. Among patients with good therapeutic effects the level of motivation to quit smoking was higher (p < 0.001 vs. p < 0.007). The level of motivation was correlated with the severity of depression symptoms (p < 0.005) but not with nicotine dependence, age and sex. Motivation to stop smoking is related to the depression symptoms (beta = -0.32; p = -.01).

Patients with initially higher motivation benefit more from treatment of nicotine dependence. The level of motivation is adversely affected by the depressive mode of functioning (negative cognitive patterns, learned helplessness). It appears necessary to take into account the assessment of depressive disorders when planning treatment of nicotine dependence in patients with cardiovascular diseases.