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Smoking cessation after acute myocardial infarction: effects of a nurse-managed intervention
C B Taylor1, N Houston-Miller, J D Killen
1Stanford University School of Medicine, California.
Insights
A nurse-led smoking cessation program significantly reduced smoking rates in myocardial infarction patients. This intervention, focused on relapse prevention, showed higher success rates one year post-myocardial infarction.
Area of Science:
- Cardiology
- Public Health
- Nursing
Background:
- Smoking is a major risk factor for myocardial infarction (MI).
- Post-MI smoking cessation is crucial for secondary prevention.
- Effective interventions are needed to support smoking cessation in this high-risk population.
Purpose of the Study:
- To evaluate the effectiveness of a nurse-managed smoking cessation intervention for patients following an acute myocardial infarction.
- To assess the impact of the intervention on smoking relapse rates at 12 months post-MI.
Main Methods:
- A randomized controlled trial was conducted with 173 patients aged 70 or younger, who were smokers before hospitalization for acute MI.
- The intervention group received a nurse-managed program including an in-hospital initiation, telephone-based follow-up, and a relapse prevention manual.
- The control group received usual care. Follow-up was conducted for 12 months.
Main Results:
- Biochemically verified smoking cessation rates at 12 months were 71% in the intervention group versus 45% in the usual care group (26% difference).
- Even when accounting for patients lost to follow-up, the cessation rate was 61% in the intervention group compared to 32% in the usual care group (29% difference).
- Patients with early relapse or low initial intention to quit were less likely to achieve sustained cessation.
Conclusions:
- A nurse-managed, telephone-based smoking cessation intervention is effective in significantly reducing smoking rates in patients post-myocardial infarction.
- Relapse prevention strategies are key components of successful smoking cessation programs for cardiac patients.
- This intervention demonstrates a valuable approach for improving long-term outcomes in patients with cardiovascular disease.
Study Objective:
To determine the effect of a nurse-managed intervention for smoking cessation in patients who have had a myocardial infarction.
Design:
Randomized, with a 6-month treatment period and a 6-month follow-up.
Setting:
Kaiser Foundation hospitals in Redwood City, Santa Clara, Hayward, and San Jose, California.
Patients:
Sequential sample of 173 patients, 70 years of age or younger, who were smoking before hospitalization for acute myocardial infarction. Eighty-six patients were randomly assigned to the intervention and 87 to usual care; 130 patients (75%) completed the study and were available for follow-up.
Intervention:
Nurse-managed and focused on preventing relapse to smoking, the intervention was initiated in the hospital and maintained thereafter primarily through telephone contact. Patients were given an 18-page manual that emphasized how to identify and cope with high-risk situations for smoking relapse.
Measurements And Main Results:
One year after myocardial infarction, the smoking cessation rate, verified biochemically, was 71% in the intervention group compared with 45% in the usual care group, a 26% difference (95% CI, 9.5% to 42.6%). Assuming that all surviving patients lost to follow-up were smoking, the 12-month smoking cessation rate was 61% in the intervention group compared with 32% in the usual care group, a 29% difference (95% CI, 14.5% to 43.5%). Patients who either resumed smoking within 3 weeks after infarction or expressed little intention of stopping in the hospital were unlikely to have stopped by 12 months.
Conclusions:
A nurse-managed smoking cessation intervention largely conducted by telephone, initiated in the hospital, and focused on relapse prevention can significantly reduce smoking rates at 12 months in patients who have had a myocardial infarction.
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