Systemic interventions boost smoking cessation after heart attack

A systematic implementation of evidence-based interventions helps improve smoking cessation in postmyocardial infarction (MI) patients, a recent study has found.

Drawing from six Swedish hospitals, the researchers compared the likelihood of smoking cessation 2 months after MI in 601 patients admitted before and 632 admitted after the systematic implementation of targeted interventions.

These cessation interventions included nurses offering smokers consultation during admission, optimizing nicotine replacement therapy and varenicline prescription, and contacting patients during the first week after discharge.

Following the implementation of these practices, there was a larger proportion of patients who were abstinent at 2 months post-MI than before the interventions were implemented (65 percent vs 54 percent). Logistic regression confirmed that such implementation led to 60-percent greater odds of abstinence (odds ratio [OR], 1.60m 95 percent confidence interval [CI], 1.04–2.48).

Moreover, after implementation, a significant rise was observed in the percentage of patients counselled during admission (50 percent vs 6 percent), who were prescribed varenicline (23 percent vs 7 percent), and who were contacted in the week following discharge (18 percent vs 2 percent; p<0.001).

Notably, being contacted postdischarge (OR, 2.74, 95 percent CI, 1.02–7.35) and being prescribed varenicline (OR, 0.39, 95 percent CI, 0.19–0.83) also emerged as significant and independent predictors of cessation at 2 months.

“The result was substantial even though far from all patients were subject to all implemented routines,” the researchers said. “The most plausible barrier to implementing the new routines was lack of time for the cardiac rehabilitation (CR) nurses. Strengthening CR nurse resources for this important task should thus be a priority.”