Abstract
BackgroundTobacco smoking is one of the most important risk factors of coronary heart disease (CHD). Hence, smoking cessation is considered pivotal in the prevention of CHD. The current study aimed to evaluate smoking cessation patterns and determine factors associated with smoking cessation in patients with established CHD.MethodsThe fourth European Survey of Cardiovascular Disease Prevention and Diabetes investigated quality of CHD care in 24 countries across Europe in 2012/13. In the German subset, smoking cessation patterns and clinical characteristics were repetitively assessed a) during index event due to CHD by medical record abstraction, b) as part of a face-to-face interview 6 to 36 months after the index event (i.e. baseline visit), and c) by telephone-based follow-up interview two years after the baseline visit. Logistic regression analysis was performed to search for factors determining smoking status at the time of the telephone interview.ResultsOut of 469 participants available for follow-up, 104 (22.2%) had been classified as current smokers at the index event. Of those, 65 patients (62.5%) had quit smoking at the time of the telephone interview, i.e., after a median observation period of 3.5 years (quartiles 3.0, 4.1). Depressed mood at baseline visit and higher education level were less prevalent amongst quitters vs non-quitters (17.2% vs 35.9%, p = 0.03 and 15.4% vs 33.3%, p = 0.03), cardiac rehabilitation programs were more frequently attended by quitters (83.1% vs 48.7%, p < 0.001), and there was a trend for a higher prevalence of diabetes at baseline visit in quitters (37.5% vs 20.5%, p = 0.07). In the final multivariable model, cardiac rehabilitation was associated with smoking cessation (OR 5.19; 95%CI 1.87 to 14.46; p = 0.002).DiscussionAttending a cardiac rehabilitation program after a cardiovascular event was associated with smoking cessation supporting its use as a platform for smoking cessation counseling and relapse prevention.
Highlights
Tobacco smoking is one of the most important risk factors of coronary heart disease (CHD)
Between August 2012 and March 2013, a total of 1380 persons were invited to participate in the German EuroAspire IV survey and 536 (38.8%) participated in the baseline visit
As compared to smokers at index event participating in the telephone-based follow-up interview (n = 104) non-participating smokers (n = 20) were older, more often diabetic and more often smokers at the baseline visit
Summary
Tobacco smoking is one of the most important risk factors of coronary heart disease (CHD). Smoking cessation is considered pivotal in the prevention of CHD. Smoking remains a leading risk factor for a variety of diseases and belongs to the most important causes of preventable death [1]. Coronary heart disease (CHD) was the leading single cause of death in the year 2015 [2]. Thirteen smokers need to quit to save one life by smoking cessation after myocardial infarction [3]. Smoking cessation is a pivotal, guideline-supported recommendation in the setting of both primary and secondary prevention of CHD [5]. After an acute cardiac event, approximately half of prior smokers quit smoking [6]. Successful cessation is predominantly driven by discharge recommendations for cardiac rehabilitation, absence of depressed mood and coronary surgery during index hospitalization [7, 8]
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