Continuous Abstinence Rates from Smoking Over 12 Months according to the Frequency of Participation in a Hospital-based Smoking Cessation Program among Patients Discharged after Acute Myocardial Infarction

Article information

Korean J Health Promot. 2016;16(1):48-55

Publication date (electronic) : 2016 January 20

doi : https://doi.org/10.15384/kjhp.2016.16.1.48

Young-Hoon Lee ¹^,²^,³, Mi-Hee Han ³, Mi Rim Lee ², Jin-Won Jeong ²^,⁴, Nam-Ho Kim ²^,⁴, Seok Kyu Oh ²^,⁴, Kyeong Ho Yun ²^,⁴, Sang Jae Rhee ²^,⁴, Jum Suk Ko ²^,⁴, Gyung-Jae Oh ¹^,²^,³^,

¹Department of Preventive Medicine and Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea

²Jeonbuk Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea

³Jeonbuk Tobacco Control Center, Wonkwang University Hospital, Iksan, Korea

⁴Division of Cardiology, Department of Internal Medicine, Wonkwang University School of Medicine and Hospital, Iksan, Korea

Corresponding author: Gyung-Jae Oh, MD, PhD Institute of Wonkwang Medical Science, Department of Preventive Medicine, Wonkwang University School of Medicine, 895 Muwang-ro, Iksan 54538, Korea Tel: +82-63-850-6781, Fax: +82-63-859-1995 E-mail: pmokj@wonkwang.ac.kr

Received 2015 July 19; Accepted 2015 February 05.

Abstract

Background

This study evaluated the continuous abstinence rates from smoking at 12-month after a hospital-based smoking cessation program was applied for smokers hospitalized for acute myocardial infarction.

Methods

Among those who are hospitalized for acute myocardial infarction from January 2012 to December 2013, ninety-eight smokers agreed to quit smoking were eligible for follow up to 12 months. Each of them underwent six consecutive sessions (first during admission, the other 5 sessions after discharge) of behavioral modification, counseling for withdrawal symptoms, and anti-smoking advices by a trained nurse. Exhaled carbon monoxide measurements less than 6 ppm were used to confirm the smoking cessation status of each participant.

Results

Mean age of all participants was 55.2±10.8 years old, and their continuous abstinence rates at 1, 3, 6, 12 months were 63.3%, 49.0%, 43.9%, and 37.8% for each. The continuous abstinence rate from smoking after 12 months was 69.7% and significantly higher in those who completed the 6 sessions than 21.5% in those who completed 5 sessions or less (P＜0.001). After adjustment for general and smoking-related characteristics, multivariate logistic regression analysis revealed that full participation relative to 5 or less participation was significantly associated with higher continuous abstinence rate from smoking at 12 months (odds ratio: 7.96; 95% confidence interval: 2.07–30.55).

Conclusions

The consistency of participating in a hospital-based smoking cessation program, described herein, significantly improved success rates of smoking cessation in patients discharged after acute myocardial infarction. Hospital-based smoking cessation program based on education and counseling should be included as an important part of patient management for acute myocardial infarction.

Figure 1.

Continuous abstinence rates from smoking decreased from 63.3% at 1 month to 37.8% at 12 month in patients discharged after acute myocardial infarction who participated in hospital-based smoking-cessation program.

Figure 2.

Continuous abstinence rates from smoking were higher in patients discharged after acute myocardial infarction who participated in smoking-cessation program of 6 times versus ≤5 times.

Table 1.

General characteristics of subjects according to the frequency of participating in smoking cessation program

Table 2.

Smoking-related characteristics of subjects according to the frequency of participating in smoking cessation program

Table 3.

OR (95% CI) for persistent smoking cessation after 6 and 12 month according to the frequency of participating in smoking cessation program in patient with myocardial infarction

References

1. Burns DM. Epidemiology of smoking-induced cardiovascular disease. Prog Cardiovasc Dis 2003;46(1):11–29.

2. Prescott E, Hippe M, Schnohr P, Hein HO, Vestbo J. Smoking and risk of myocardial infarction in women and men: longitudinal population study. BMJ 1998;316(7137):1043–7.

3. Wilson K, Gibson N, Willan A, Cook D. Effect of smoking cessation on mortality after myocardial infarction: metaanalysis of cohort studies. Arch Intern Med 2000;160(7):939–44.

4. Critchley JA, Capewell S. Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review. JAMA 2003;290(1):86–97.

5. Kinjo K, Sato H, Sakata Y, Nakatani D, Mizuno H, Shimizu M, et al. Impact of smoking status on longterm mortality in patients with acute myocardial infarction. Circ J 2005;69(1):7–12.

6. Gerber Y, Rosen LJ, Goldbourt U, Benyamini Y, Drory Y. Israel Study Group on First Acute Myocardial Infarction. Smoking status and longterm survival after first acute myocardial infarction a population-based cohort study. J Am Coll Cardiol 2009;54(25):2382–7.

7. Rigotti NA, Clair C, Munafò MR, Stead LF. Interventions for smoking cessation in hospitalised patients. Cochrane Database Syst Rev 2012;5:CD001837.

8. Seol SY, Lee SJ, Jeong MH, Rhee JA, Choi JS, Hwang SH, et al. Clinical outcomes of persistent smoking in patients with acute myocardial infarction who underwent percutaneous coronary intervention. 2011;80(5):562–70.

9. Godtfredsen NS, Osler M, Vestbo J, Andersen I, Prescott E. Smoking reduction, smoking cessation, and incidence of fatal and non-fatal myocardial infarction in Denmark 1976–1998: a pooled cohort study. J Epidemiol Community Health 2003;57(6):412–6.

10. Iversen B, Jacobsen BK, L⊘chen ML. Active and passive smoking and the risk of myocardial infarction in 24,968 men and women during 11 year of follow-up: the Troms⊘ Study. Eur J Epidemiol 2013;28(8):659–67.

11. Kim HE, Song YM, Kim BK, Park YS, Kim MH. Factors associated with persistent smoking after the diagnosis of cardiovascular disease. Korean J Fam Med 2013;34(3):160–8.

12. Sim DS, Kim JH, Jeong MH. Differences in clinical outcomes between patients with ST-elevation versus non-ST-elevation acute myocardial infarction in Korea. Korean Circ J 2009;39(8):297–303.

13. Krumholz HM, Cohen BJ, Tsevat J, Pasternak RC, Weinstein MC. Cost-effectiveness of a smoking cessation program after myocardial infarction. J Am Coll Cardiol 1993;22(6):1697–702.

14. Van Spall HG, Chong A, Tu JV. Inpatient smoking-cessation counseling and all-cause mortality in patients with acute myocardial infarction. Am Heart J 2007;154(2):213–20.

15. Dawood N, Vaccarino V, Reid KJ, Spertus JA, Hamid N, Parashar S. PREMIER Registry Investigators. Predictors of smoking cessation after a myocardial infarction: the role of institutional smoking cessation programs in improving success. Arch Intern Med 2008;168(18):1961–7.

16. Dornelas EA, Sampson RA, Gray JF, Waters D, Thompson PD. A randomized controlled trial of smoking cessation counseling after myocardial infarction. Prev Med 2000;30(4):261–8.

17. Jun WH, Yun HS. Effects of smoking cessation education for patients with percutaneous coronary intervention. 2012;24(3):274–83.

18. Kong JH, Ha Y. Effects of a smoking cessation program including telephone counseling and text messaging using stages of change for outpatients after a myocardial infarction. 2013;43(4):557–67.

19. Jung KY, Yoo SH, Ma SH, Hong SH, Lee YS, Shim UY, et al. Inpatient smoking cessation program and its success rate for abstinence among Korean smokers. Korean J Fam Med 2009;30(7):503–10.

20. Kang SH, Suh JW, Choi DJ, Chae IH, Cho GY, Youn TJ, et al. Cigarette smoking is paradoxically associated with low mortality risk after acute myocardial infarction. Nicotine Tob Res 2013;15(7):1230–8.

21. Weiner P, Waizman J, Weiner M, Rabner M, Magadle R, Zamir D. Smoking and first acute myocardial infarction: age, mortality and smoking cessation rate. Isr Med Assoc J 2000;2(6):446–9.

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Figure 1.

Figure 2.

Continuous abstinence rates from smoking were higher in patients discharged after acute myocardial infarction who participated in smoking-cessation program of 6 times versus ≤5 times.

Table 1.

General characteristics of subjects according to the frequency of participating in smoking cessation program

	Total (n＝98)	≤ 5 times (n＝65)	6 times (n＝33)	P^a
	n	n	n	P^a
Age, y	55.2±10.8	55.9±10.7	53.8±11.0	0.362
＜60	68 (69.4)	20 (69.2)	23 (69.7)	0.962
≥ 60	30 (30.6)	10 (30.8)	10 (30.3)
Duration of education, y
≤ 9	40 (40.8)	28 (43.1)	12 (36.4)	0.523
≥ 10	58 (59.2)	37 (56.9)	21 (63.6)
Health insurance
Medical aid	8 (8.2)	5 (7.7)	3 (9.1)	0.811
National health insurance	90 (91.8)	60 (92.3)	30 (90.9)
Family type
Living alone	25 (25.5)	18 (27.7)	7 (21.2)	0.268
Living with family	65 (66.3)	40 (61.5)	25 (75.8)
Non-response	8 (8.2)	7 (10.8)	1 (3.0)
Occupation
Manual	44 (44.9)	26 (40.0)	18 (54.5)	0.182
Non-manual	14 (14.3)	12 (18.5)	2 (6.1)
Others (unemployed, housewife, non-response)	40 (40.8)	27 (41.5)	13 (39.4)
Alcohol drinking
No	64 (65.3)	43 (66.2)	21 (63.6)	0.805
Yes	34 (34.7)	22 (33.8)	12 (36.4)
Hypertension
Absent	65 (66.3)	43 (66.2)	22 (66.7)	0.960
Present	33 (33.7)	22 (33.8)	11 (33.3)
Diabetes mellitus
Absent	78 (79.6)	49 (75.4)	29 (87.9)	0.147
Present	20 (20.4)	16 (24.6)	4 (12.1)
Dyslipidemia
Absent	89 (90.8)	58 (89.2)	31 (93.9)	0.446
Present	9 (9.2)	7 (10.8)	2 (6.1)
Past history of coronary heart disease
No	91 (92.9)	60 (92.3)	31 (93.9)	0.767
Yes	7 (7.1)	5 (7.7)	2 (6.1)
Killip class
Ⅰ	93 (94.9)	62 (95.4)	31 (93.9)	0.759
Ⅱ-Ⅳ	5 (5.1)	3 (4.6)	2 (6.1)

Values are presented as N (%) or mean±SD.

Calculated by chi-square test or independent t-test.

Table 2.

Smoking-related characteristics of subjects according to the frequency of participating in smoking cessation program

	Total (n＝98)	≤ 5 times (n＝65)	6 times (n＝33)	P^a
	n	n	n	P^a
Presence of smokers among family members				0.834
Absent	22 (22.4)	15 (23.1)	7 (21.2)
Present	76 (77.6)	50 (76.9)	26 (78.8)
Previous exposure to anti-smoking education				0.979
No	86 (87.8)	57 (87.7)	29 (87.9)
Yes	12 (12.2)	8 (12.3)	4 (12.1)
Previous attempts to quit smoking				0.026
No	42 (42.9)	33 (50.8)	9 (27.3)
Yes	56 (57.1)	32 (49.2)	24 (72.7)
Amount of smoking				0.139
＜1 pack	71 (72.4)	44 (67.7)	27 (81.8)
≥ 1 pack	27 (27.6)	21 (32.3)	6 (18.2)
Age at starting smoking				0.831
＜20 yr	49 (50.0)	33 (50.8)	16 (48.5)
≥ 20 yr	49 (50.0)	32 (49.2)	17 (51.5)
Duration of smoking, y				0.577
＜30	32 (32.7)	20 (30.8)	12 (32.7)
≥ 30	66 (67.3)	45 (69.2)	21 (67.3)
Participation in a heart rehabilitation program				0.171
0 sessions	39 (39.8)	29 (44.6)	10 (30.3)
≥ 1 sessions	59 (60.2)	36 (55.4)	23 (69.7)
Participation in a follow-up heart education				＜0.001
0 sessions	38 (38.8)	35 (53.8)	3 (9.1)
≥ 1 sessions	60 (61.2)	30 (46.2)	30 (90.9)

Values are presented as N (%).

Calculated by chi-square test.

Table 3.

OR (95% CI) for persistent smoking cessation after 6 and 12 month according to the frequency of participating in smoking cessation program in patient with myocardial infarction

	After 6 month	After 12 month
	OR (95% CI)	OR (95% CI)
Frequency of smoking cessation program
≤ 5 times	1.00	1.00
6 times	10.36 (2.36–45.59)	7.96 (2.07–30.55)

Abbreviations: OR, odds ratio; CI, confidence interval. Adjusted for age, duration of education, health insurance, family type, occupation, alcohol drinking, hypertension, diabetes mellitus, dyslipidemia, past history of coronary heart disease, Killip class, presence of smokers among family members, previous exposure to anti-smoking education, previous attempts to quit smoking, amount of smoking, age at starting smoking, duration of smoking, participation in a heart rehabilitation program, and participation in a follow-up heart education