Abstract
BackgroundCardiovascular disease (CVD) prevention guidelines stress the importance of smoking cessation and recommend intensive follow-up. To guide the development of such cessation support strategies, we analysed the characteristics that are associated with successful smoking cessation after an acute coronary syndrome (ACS).MethodsWe used data from the Randomised Evaluation of Secondary Prevention for ACS patients coordinated by Outpatient Nurse SpEcialists (RESPONSE) trial (n = 754). This was designed to quantify the impact of a nurse-coordinated prevention program, focusing on healthy lifestyles, traditional CVD risk factors and medication adherence. For the current analysis we included all smokers (324/754, 43 %). Successful quitters were defined as those who reported abstinence at 1 year of follow-up.ResultsThe majority of successful quitters quit immediately after the ACS event and remained abstinent through 1 year of follow-up, without extra support (128/156, 82 %). Higher education level (33 vs. 15 %, p < 0.01), no history of CVD (87 vs. 74 %, p < 0.01) and being on target for LDL-cholesterol level at 1 year (78 vs. 63 %, p < 0.01) were associated with successful quitting.ConclusionThe majority of successful quitters at 1 year stopped immediately after their ACS. Patients in this group showed that it was within their own ability to quit, and they did not relapse through 1 year of follow-up. Our study indicates that in a large group of patients who quit immediately after a life-threatening event, no relapse prevention program is needed.
Highlights
Coronary heart disease (CHD) patients are at high risk of recurrent coronary events and mortality
With the RESPONSE trial we evaluated whether a nurse-coordinated prevention program leads to better achievement of guideline-recommended Cardiovascular disease (CVD) prevention targets [20]
We used the Systematic Coronary Risk Evaluation (SCORE) as an integrated measure to estimate the overall impact of smoking cessation on cardiovascular risk
Summary
Coronary heart disease (CHD) patients are at high risk of recurrent coronary events and mortality. Smoking cessation after CHD is diagnosed is potentially the most effective preventive measure It is associated with a 33 %-50 % reduction in risk of recurrent myocardial infarctions or cardiovascular death [3,4,5] and a life expectancy gain of 3 years after coronary artery bypass surgery [6]. With the RESPONSE trial we evaluated whether a nurse-coordinated prevention program leads to better achievement of guideline-recommended CVD prevention targets [20]. We found this program improved blood pressure and lipid management, but did not have a significant impact on lifestyle factors, including smoking cessation [20]. We addressed the following research question: what are the characteristics of successful quitters after a recent ACS?
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