A multifactorial smoking cessation programme for patients with coronary artery disease: experiences and preliminary...

Smoking is a known risk factor for coronary artery disease (CAD) and recurrent cardiac events in patients with established CAD. Although cessation can lead to a risk reduction of up to 50% following an initial myocardial infarction, at least 20% of cardiac patients continue to smoke.

To describe and evaluate the effects of a comprehensive, multifactorial smoking cessation programme in outpatients with CAD, and to delineate variables that impede smoking cessation.

Patients with a confirmed diagnosis of CAD recruited from the outpatient cardiology clinic, Dijkzigt University Hospital, Rotterdam, participated in the cessation programme and were followed for three months. Endpoint was smoking cessation.

Purpose-designed and validated questionnaires were used to assess smoking history, sociodemographic and psychological parameters. Information on cardiac history was sampled from medical records. Height and blood pressure were measured at baseline, and weight and expiratory CO at every group session of the cessation programme.

One third of the patients recruited for the programme achieved cessation at three months. Quitters generally smoked less, were less addicted, scored lower on anxiety and depression, and had more recently been diagnosed with CAD. Type D personality was an impediment to cessation (OR:3.50; 95% CI: 0.40-35.48).

Thirty-two percent of the patients achieved cessation at three months. Cessation efforts should be started in-hospital or as early as possible following diagnosis. An interdisciplinary and multifactorial approach seems warranted, in particular given the negative influence of anxiety, depression, and Type D personality on cessation.