Cost effectiveness of a smoking cessation program in patients admitted for coronary heart disease.

BACKGROUND: Smoking cessation is probably the most important action to reduce mortality after a coronary event. Smoking cessation programs are not widely implemented in patients with coronary heart disease, however, possibly because they are thought not to be worth their costs. Our objectives were to estimate the cost effectiveness of a smoking cessation program, and to compare it with other treatment modalities in cardiovascular medicine. METHODS: A cost-effectiveness analysis was performed on the basis of a recently conducted randomized smoking cessation intervention trial in patients admitted for coronary heart disease. The cost per life year gained by the smoking cessation program was derived from the resources necessary to implement the program, the number needed to treat to get one additional quitter from the program, and the years of life gained if quitting smoking. The cost effectiveness was estimated in a low-risk group (i.e. patients with stable coronary heart disease) and a high-risk group (i.e. patients after myocardial infarction or unstable angina), using survival data from previously published investigations, and with life-time extrapolation of the survival curves by survival function modeling. RESULTS: In a lifetime perspective, the incremental cost per year of life gained by the smoking cessation program was euro 280 and euro 110 in the low and high-risk group, respectively (2000 prices). These costs compare favorably to other treatment modalities in patients with coronary heart disease, being approximately 1/25 the cost of both statins in the low-risk group and angiotensin-converting enzyme inhibitors in the high-risk group. In a sensitivity analysis, the costs remained low in a wide range of assumptions. CONCLUSIONS: A nurse-led smoking cessation program with several months of intervention is very cost-effective compared with other treatment modalities in patients with coronary heart disease.     

重视冠心病患者吸烟干预

WHO估计到2025年将有1000万人死于吸烟引起的相关疾病.在15～59岁人群中,61%的疾病负担归因为吸烟.在过去的几十年,中国男性的吸烟率虽然有所下降,如2000-2001年成人男性吸烟率为60.2%[1],第四次国家卫生服务调查显示,2008年15岁以上人口男性吸烟率为48.0%,但吸烟仍然是我国公共卫生重大问题之一.     

Predictors of smoking cessation in patients with a diagnosis of coronary artery disease

PURPOSE: This study aimed to examine demographic, psychosocial, and clinical variables as predictors of smoking cessation in patients with coronary artery disease. METHODS: Smoking status and psychosocial variables were obtained at baseline. Participants were followed up at 3 months then annually up to 6 years for smoking status. Participants were recruited from the population of patients undergoing coronary angiography from 1986 through 1990. Patients were included in the study if they reported smoking at baseline and had valid data for demographic and clinical measures of interest. Depending on the psychosocial measure analyzed, sample size ranged from 525 to 303. Age, gender, education, marital status, disease severity, cardiac procedure, hostility, and four ratings of distress were evaluated as predictors of smoking cessation. RESULTS: Of the full sample, 40% (n = 210) quit smoking without relapse. Education (odds ratio [OR] 0.61; 95% confidence interval [CI] 0.44-0.84; P <.003), disease severity (OR 0.58; 95% CI 0.40-0.84; P <.004), and coronary artery bypass surgery (OR 0.60; 95% CI 0.43-0.85; P <.004) were associated with a lower likelihood of relapse. Higher levels of hostility (OR 2.36; 95% CI 1.46-3.84; P <.001), concern about health (OR 1.90; 95% CI 1.33-2.74; P <.001), tension (OR 1.60; 95% CI 1.12-2.30; P <.012), and depressive feelings (OR 1.60; 95% CI 1.12-2.27; P <.010) were associated with a higher risk of continuing to smoke. CONCLUSIONS: These findings describe demographic, clinical, and psychological mechanisms that might underlie successful smoking cessation and also may guide the identification of patients in need of special intervention.     

Predictors of success in smoking cessation among hospitalized patients

OBJECTIVE: To determine the predictors of continued smoking abstinence in patients receiving smoking cessation intervention during and following hospital admission. METHODOLOGY: A prospective cohort study was conducted in a university-affiliated hospital. A total of 248 smokers admitted with primary cardiac and respiratory conditions received verbal advice (lasting about 1 h) and standard booklets on smoking cessation from a dedicated nurse counsellor. After discharge, participants received follow-up telephone counselling calls every 2 weeks from the same smoking counsellor. The main outcome measure was continued abstinence at 2 months after hospital discharge, as determined by self-reporting and carbon monoxide breath testing. The following groups of covariates were analysed to determine the possible factors associated with smoking abstinence: demographics, smoking history, readiness to quit, and medical history. RESULTS: At 2 months post-discharge, 108 (43.5%) patients remained abstinent. Low nicotine dependence score (odds ratio, 2.30; 95% CI, 1.25-4.26; P = 0.008), decision to quit by sudden cessation as compared to reduction of smoking (odds ratio, 7.19; 95% CI, 1.56-33.06; P = 0.011), and initial hospitalization for their medical condition (odds ratio, 6.37; 95% CI, 1.33-30.44; P = 0.020) were the main independent predictors for positive outcome. CONCLUSION: Among this cohort of hospitalized patients receiving smoking cessation intervention, low dependence on tobacco, motivation to quit by sudden cessation, and initial hospitalization were the main independent predictors of smoking abstinence after discharge from hospital.     

Short-term benefit of smoking cessation in patients with coronary heart disease: estimates based on self-reported smoking data and serum cotinine measurements.

AIMS: To assess the short-term impact of smoking and smoking cessation measured by self-report and by serum cotinine on the risk of secondary cardiovascular disease events (CVD events). METHODS AND RESULTS: Cohort study among participants of an in-patient 3-week rehabilitation programme following an acute coronary syndrome or coronary artery revascularization. Smoking status at baseline was assessed by self-report (beginning of the rehabilitation programme, rehab) and serum cotinine (end of rehab). Active follow-up was conducted one year later. Subsequent CVD events were observed in 139 of the 967 patients. Both self-reported smoking status (odds ratio (OR) compared to continued smokers: recent quitters 0.96, former smokers 0.83, never smokers 0.54, p for trend 0.04) and serum cotinine (OR 0.59 (95% confidence interval (CI) 0.36-0.97) for cotinine-negative compared to cotinine-positive subjects) were associated with the occurrence of a secondary CVD event. After reclassification of all cotinine-positive subjects to continued smokers and cotinine-negative self-reported smokers to recent quitters, this association became even stronger. The OR now reached 0.71 (95% CI interval 0.38-1.33) for recent quitters, 0.64 (0.36-1.11) for former smokers and 0.44 (0.24-0.81) for never smokers (p-value for trend=0.009). CONCLUSION: The benefits of non-smoking and smoking cessation in cardiac patients are beyond controversy and might even be larger than suggested by previous studies which exclusively relied on self-reported smoking status.     

Promoting smoking cessation during hospitalization for coronary artery disease

BACKGROUND: Quitting smoking is the most effective intervention to reduce mortality in patients with coronary artery disease who smoke. Guidelines for the treatment of tobacco dependency recommend that health care institutions develop plans to support the consistent and effective identification and treatment of tobacco users. The University of Ottawa Heart Institute (Ottawa, Ontario) has implemented an institutional program to identify and treat all smokers admitted to the Institute. OBJECTIVES: The objectives of the present paper are to describe core elements of this program and present data concerning its reach and effectiveness. PROGRAM DESCRIPTION: The goal of the program is to increase the number of smokers who are abstinent from smoking six months after a coronary artery disease-related hospitalization. Core elements of the program include: documentation of smoking status at hospital admission; inclusion of cessation intervention on patient care maps; individualized, bedside counselling by a nurse counsellor; the appropriate and timely use of nicotine replacement therapy; automated telephone follow-up; referral to outpatient cessation resources; and training of medical residents and nursing staff. Program reach and effectiveness were measured over a one-year period. RESULTS: Between April 2003 and March 2004, almost 1300 smokers were identified at admission, and 91% received intervention to help them quit smoking. At six-month follow-up, 44% were smoke-free. CONCLUSIONS: Hospitalization for coronary artery disease provides an important opportunity to intervene with smokers when their motivation to quit is high. An institutional approach reinforces the importance of smoking cessation in this patient population and increases the rate of smoking cessation. Posthospitalization quit rates should be a benchmark of cardiac program performance.     

吸烟的冠心病患者戒烟现状及影响因素分析

目的 了解吸烟的冠心病患者对于吸烟问题的认识及戒烟状况,揭示戒烟及戒烟未成功的原因和影响因素,为更有效地帮助冠心病患者控烟提供参考.方法 对350例吸烟的冠心病患者进行问卷调查,包括性别、年龄、吸烟史等,采用分组分析、logistic回归分析等方法分析戒烟的影响因素.结果 350例吸烟的冠心病患者平均年龄(59.6±10.2)岁,男321例(占91.7%).57.1%(200/350)的患者已戒烟,42.9%(150/350)的患者目前仍在吸烟.将患者按年龄分两组,非老年组患者(≤65岁,n=239)戒烟率50.6%,显著低于老年组患者(>65岁,n=111)的71.2%(P<0.001).非老年组有戒烟意愿及尝试过戒烟的比例分别为70.3%和48.3%,均低于老年组的81.2%和59.4%(P<0.001).76例戒烟复吸者中,复吸最主要原因为缺乏自我控制能力,占76.3%.logistic回归分析,影响戒烟未成功的因素:年龄≤65岁(OR=2.336,P=0.004)、文化程度低(OR=1.310,P=0.028)、行经皮冠状动脉介入治疗术(OR=0.261,P<0.001)、行冠状动脉旁路移植术(OR=0.107,P=0.004)、家庭总收入>4000 元/月(OR=1.828,P=0.003).结论 吸烟的冠心病患者戒烟水平和意识仍有待提高;除现有的控烟政策外,应更加关注中青年、文化程度较低、未行经皮冠状动脉介入治疗及冠状动脉旁路移植术、家人有人吸烟、体质指数及家庭总收入越高的吸烟冠心病患者的控烟活动;在针对吸烟冠心病患者控烟活动的同时对其周围环境宣传控烟活动也是迫切需要的.

Abstract：

Objective To investigate the status quo of smoking cessation and analyze factors influencing smoking cessation in cigarette smoking patients with coronary artery disease(CAD).Method A total of 350 smoking patients with CAD was surveyed by questionnaire,logistic regression analysis was performed to analyze factors influencing smoking cessation.Results Incidence of smoking cessation was 57.1%(200/350)in this cohort.Patients were divided into two groups,the elderlv(>65 years old,n=111)and the young group(≤65 years old,n=239).The smoking cessation rate in the elderlv group is significantly higher than in the young group(71.2%vs.50.6%,P<0.001).Aged patients and patients with high cultural level are easier to give up smoking.Logistic analysis showed that age≤65 years old (OR=2.336,P=0.004),low cultural level(OR=1.310,P=0.028),PCI(OR=0.261.P<0.001).coronary artery bypass graft(OR=0.107,P=0.004),total family income>4000 RMB/month (OR=1.828,P=0.003)are risk factors for failed smoking cessation.There are 76 patients smoking again in current smokers,most due to lack of self-control(76.3%).Compared to the elderly group,there is a higher proportion of smoking again due to the need of daily communication and work in the young group.Conclusions We still need to raise the awareness of smoking cessation for smoking patients with CAD.Following factors should be focused for tobacco control in CAD patients:younger age,lower cuItural level,not treated with PCI or CABG,patients with smoking family members.higher body mass index and higher total family income.     

经皮冠状动脉介入治疗急性冠脉综合征患者戒烟后残余心血管疾病的风险评估

目的 探讨行经皮冠状动脉介入治疗(PCI)的急性冠脉综合征(ACS)患者戒烟后残余心血管疾病的风险。方法 本研究基于中国冠心病患者大型登记注册研究(OPT-CAD),纳入2012年1月至2014年2月入选OPT-CAD研究的ACS且行PCI的患者,依据吸烟状态(从未吸烟、正在吸烟及已戒烟1年以上)分为未吸烟、吸烟及戒烟3组,比较3组临床资料及介入手术特征、5年临床随访主要心脑血管不良事件(MACCE)的发生情况。所有的数据分析均基于R语言4.1.2版本,通过Trimatch包进行3组倾向性评分匹配。根据数据类型,组间比较分别采用t检验、Wilcoxon检验及χ²检验。采用Kaplan-Meier方法绘制累计事件发生曲线并通过log-rank检验进行组间比较。结果 进行倾向性评分匹配后3组患者基线特征基本一致。倾向性评分匹配前,3组1、5年MACCE发生率比较,差异均无统计学意义。倾向性评分匹配后,3组患者1年MACCE发生率差异无统计学意义;吸烟组、戒烟组及未吸烟组患者1年靶血管血运重建率比较,差异有统计学意义[28(3.7%)和24(3.2%)和12(1.6%)...     

戒烟对急性冠脉综合征患者血清炎症标志物水平的影响

目的 探讨戒烟对急性冠脉综合征（ACS）患者血清炎症标志物水平的影响.方法 对216例有吸烟史的ACS患者进行一般情况调查,按是否戒烟分为两组：戒烟组和吸烟组,另取同期40例无吸烟史的ACS患者为对照组.检测所有患者空腹血清高敏C反应蛋白（hs-CRP）、纤维蛋白原水平和白细胞计数.结果 ①三组之间年龄、收缩压、LDL-C、TG、血糖、饮酒、运动、BMI差异均无统计学意义,但心血管事件的发生率有统计学意义.②三组之间hs-CRP（mg/L）（4.16±0.52、5.46±0.68、2.68±0.32）、纤维蛋白原（g/L）（3.84±0.41、4.38±0.53、2.52±0.33）、白细胞计数（×109/L）（6.23±0.82、7.58±0.78、5.44±0.65）差异有统计学意义（P＜0.05）.③戒烟组依据戒烟时间亚组分析,戒烟0～1年、1～5年、5年以上各组之间hs-CRP、纤维蛋白原、白细胞计数差异有统计学意义（P＜0.05）;戒烟5年以上者血清炎症标志物水平接近无吸烟史患者.结论 戒烟可以降低ACS患者心血管事件的发生,明显降低ACS患者血清炎症标志物水平,且与戒烟时间有关.     

急性冠状动脉综合征患者吸烟现状及简单戒烟干预的临床效果评价

目的 了解急性冠状动脉综合征(ACS)并吸烟患者出院后6个月持续戒烟率、复吸率,评价简单干预的戒烟效果.方法 收集ACS并吸烟患者150例,分为简单干预组(87例)和常规治疗组(63例),随访6个月,比较两组患者2个月、6个月戒烟率、复吸率,应用logistic回归模型进行复吸相关因素分析.结果 ACS患者现吸烟率为31.14%,6个月持续戒烟率为64.6%,6个月复吸率为36.4%.简单干预组和常规治疗组6个月持续戒烟率和复吸率无差异.尼古丁依赖评分4分以上可作为复吸的预测指标.结论 ACS患者6个月持续戒烟率高于一般人群.给予简单戒烟干预不增加ACS患者戒烟成功率,需要强化干预.     

Predictors of success in a smoking cessation clinic

We identified factors associated with success among the first 531 patients referred to a Veterans Affairs Medical Center smoking cessation clinic. Both patients and providers completed questionnaires covering smoking history, other health habits, and comorbidity. The 3-month success rate was 23% of all referrals or 42% of clinic attendees. Among those referred, factors associated with their success were being at least 50 years of age, having hyperlipidemia, and not currently drinking alcohol. Among those who attended the clinic at least once, factors associated with success were being at least 50 years of age, being less physically active, and not currently drinking alcohol. Neither patients nor providers could predict who would successfully stop smoking.     

Predictors of smoking cessation in a sample of Italian smokers.

In this study we identify several pretreatment characteristics which predict abstinence at 6 months. Moreover, the persistence of withdrawal discomfort and of an increased frequency of night awakenings during the first month of abstinence, together with a tendency to "slip" during Weeks II-IV, strongly predicted relapse. Our results suggest that: 1) Predictors of outcome cannot be automatically extended from one cultural context to another; 2) a careful assessment of certain variables, made while the patient is still under treatment, provides significant prognostic hints; 3) ex-smokers' sleeping and dreaming function has been ignored by the literature, whereas they may well be involved into the maintenance of the drug-free state.