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Smoking Cessation Advisory Intervention in Patients with Cardiovascular Disease.

ABSTRACT: Several studies have examined the efficacy of smoking cessation therapies in the general population. However little is known about the efficacy of these advisory methods in cardiovascular patients.The aim of the study is to determine the prevalence and the characteristics of smoking abstinence in cardiovascular patients, after a smoking intervention during hospitalization.The study involved 442 patients, smokers admitted for cardiovascular disease to the Department of Cardiology. During hospitalization patient's data were collected and all patients were subjected to a 30-minutes long advisory session with drug administration in selected cases (varenicycline, bupropione, nocitine replacement therapy), according to standard protocol. After the discharge patients were asked about smoking abstinence at time intervals of 24 hours, 1 month, 3, 6 and 12 months.After hospital discharge 11 patients (2.49%) could not be contacted after several attempts and 19 patients (4.3%) were died during follow up period. A total of 412 patients (218 men and 194 women, mean age 56.49+10.57 years) made up the final study population. Twenty four hours after hospital discharge 364 patients (88.35%) had quitted smoking. At 1, 3, 6 and 12 months the abstinence rates were 70.87%, 64.8%, 55.82% and 47.83% respectively. Patients with ischaemic cardiovascular diseases (angina - infarction) had a significantly higher probability of quitting smoking at 12 months (Hazard ratio: 0.64 - p=0.01).A smoking cessation program in cardiovascular patients during hospitalization was unlikely to result in success. These patients might benefit by following programs promoting smoking cessation in experienced specialized centers, involving a group of health professionals, such as psychologists and/or trained nurses.

SUBMITTER: Vogiatzis I

PROVIDER: S-EPMC5511535 | biostudies-other | 2017 Apr

REPOSITORIES: biostudies-other

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Project description:IntroductionHealth professionals' own beliefs and practices, especially their smoking status, has been described to strongly influence their willingness to provide brief tobacco interventions (5 A's) to their patients. This study examines the association between the smoking status of faculty members in US dental programmes and (1) practice pattern; (2) perceived confidence; and (3) perceived educational preparedness of new graduates in providing the 5 A's to their patients.MethodsThis study presents data from the National Tobacco Survey of Personnel in Dental and Allied Academic Programs (TSPDAP) conducted in 2018. Faculty members in US dental/allied dental schools were invited to participate in this survey. Data were stratified based on the smoking status of the respondents as "never" and "ever" smokers (smoked <100 and ≥100 cigarettes during their lifetime, respectively). Multiple logistic regression models were used to calculate the adjusted odds ratios (aORs) and 95% confidence intervals (CIs).ResultsData of 1896 participants were analysed, of whom 1032 (54.4%) were categorised as "ever" smokers. In the final regression model, low perceived barrier score was significantly associated with high practice pattern (aOR, 0.94; 95% CI, 0.92-0.97), high perceived confidence (aOR, 0.92; 95% CI, 0.90-0.95), and high perceived educational preparedness (aOR, 0.97; 95% CI, 0.94-0.98) in delivering the 5 A's to patients. Similarly, high perceived effectiveness was significantly associated with high practice pattern (aOR, 1.08; 95% CI, 1.05-1.11), high perceived confidence (aOR, 1.10; 95% CI, 1.06-1.13), and high perceived educational preparedness (aOR, 1.06; 95% CI, 1.03-1.09) in delivering the 5 A's to their patients. The smoking status of the dental personnel did not show any significant association with practice pattern, perceived confidence, or perceived educational preparedness in delivering the 5 A's to their patients.ConclusionsThe smoking status of oral health care personnel was not significantly associated with their participation in tobacco cessation interventions.

Project description:ImportanceThe time course of cardiovascular disease (CVD) risk after smoking cessation is unclear. Risk calculators consider former smokers to be at risk for only 5 years.ObjectiveTo evaluate the association between years since quitting smoking and incident CVD.Design, setting, and participantsRetrospective analysis of prospectively collected data from Framingham Heart Study participants without baseline CVD (original cohort: attending their fourth examination in 1954-1958; offspring cohort: attending their first examination in 1971-1975) who were followed up through December 2015.ExposuresTime-updated self-reported smoking status, years since quitting, and cumulative pack-years.Main outcomes and measuresIncident CVD (myocardial infarction, stroke, heart failure, or cardiovascular death). Primary analyses included both cohorts (pooled) and were restricted to heavy ever smokers (≥20 pack-years).ResultsThe study population included 8770 individuals (original cohort: n = 3805; offspring cohort: n = 4965) with a mean age of 42.2 (SD, 11.8) years and 45% male. There were 5308 ever smokers with a median 17.2 (interquartile range, 7-30) baseline pack-years, including 2371 heavy ever smokers (406 [17%] former and 1965 [83%] current). Over 26.4 median follow-up years, 2435 first CVD events occurred (original cohort: n = 1612 [n = 665 among heavy smokers]; offspring cohort: n = 823 [n = 430 among heavy smokers]). In the pooled cohort, compared with current smoking, quitting within 5 years was associated with significantly lower rates of incident CVD (incidence rates per 1000 person-years: current smoking, 11.56 [95% CI, 10.30-12.98]; quitting within 5 years, 6.94 [95% CI, 5.61-8.59]; difference, -4.51 [95% CI, -5.90 to -2.77]) and lower risk of incident CVD (hazard ratio, 0.61; 95% CI, 0.49-0.76). Compared with never smoking, quitting smoking ceased to be significantly associated with greater CVD risk between 10 and 15 years after cessation in the pooled cohort (incidence rates per 1000 person-years: never smoking, 5.09 [95% CI, 4.52-5.74]; quitting within 10 to <15 years, 6.31 [95% CI, 4.93-8.09]; difference, 1.27 [95% CI, -0.10 to 3.05]; hazard ratio, 1.25 [95% CI, 0.98-1.60]).Conclusions and relevanceAmong heavy smokers, smoking cessation was associated with significantly lower risk of CVD within 5 years relative to current smokers. However, relative to never smokers, former smokers' CVD risk remained significantly elevated beyond 5 years after smoking cessation.

Project description:Objectives: To examine the effect of smoking status, smoking intensity, duration of smoking cessation and age of smoking initiation on the risk of all-cause and cause-specific mortality among cardiovascular disease (CVD) patients. Design: A population-based prospective cohort study. Setting: The National Health Interview Survey (NHIS) in the U.S. that were linked to the National Death Index (NDI). Participants: 66,190 CVD participants ≥ 18 years of age who were interviewed between 1997 and 2013 in the NHIS linked to the NDI through December 31, 2015. Outcome Measures: The primary outcome was all-cause mortality and the secondary outcome was cause-specific mortality including CVD mortality and cancer mortality. Results: During the mean follow-up of 8.1 years, we documented 22,518 deaths (including 6,473 CVD deaths and 4,050 cancer deaths). In the overall CVD population, former and current smokers had higher risk of all-cause (Former smokers: hazard ratios (HRs), 1.26; 95% confidence interval (CI), 1.21-1.31, P < 0.001; Current smokers: HRs, 1.96; 95%CI, 1.86-2.07, P < 0.001), CVD (Former smokers: HRs, 1.12; 95%CI, 1.05-1.21, P = 0.001; Current smokers: HRs, 1.80; 95%CI, 1.64-1.97, P < 0.001) and cancer mortality (Former smokers: HRs, 1.49; 95%CI, 1.35-1.64, P < 0.001; Current smokers: HRs, 2.78; 95%CI, 2.49-3.09, P < 0.001) than never smokers. Furthermore, similar results were observed when the study subjects were stratified according to the type of CVD. Among current smokers, the risk for cancer mortality increased as the daily number of cigarettes increased, regardless of the specific type of CVD. However, the association of the risk for all-cause and CVD mortality with smoking intensity did not present a dose-response relationship. In participants with angina pectoris or stroke, smoking intensity was inversely associated with deaths from CVD. In addition, the risk for all-cause, CVD and cancer mortality declined as years of smoking cessation increased. Finally, the relative risk of all-cause mortality was not significantly different in individuals with a younger age of smoking initiation. Conclusions: CVD patients who are smokers have an increased risk of all-cause, CVD and cancer mortality, and the risk decreases significantly after quitting smoking. These data further provide strong evidence that supports the recommendation to quit smoking for the prevention of premature deaths among individuals with CVD.

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Smoking Cessation Advisory Intervention in Patients with Cardiovascular Disease.

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