SMOKING CESSATION AFTER ACUTE MYOCARDIAL-INFARCTION - EFFECTS OF A NURSE-MANAGED INTERVENTION

Study Objective: To determine the effect of a nurse-managed intervention for smoking cessation in patients who have had a myocardial infarction. Design: Randomized, with a 6-month treatment period and a 6-month follow-up. Setting: Kaiser Foundation hospitals in Redwood City, Santa Clara, Hayward, and San Jose, California. Patients: Sequential sample of 173 patients, 70 years of age or younger, who were smoking before hospitalization for acute myocardial infarction. Eighty-six patients were randomly assigned to the intervention and 87 to usual care; 130 patients (75%) completed the study and were available for follow-up. Intervention: Nurse-managed and focused on preventing relapse to smoking the intervention was initiated in the hospital and maintained thereafter primarily through telephone contact. Patients were given an 18-page manual that emphasized how to identify and cope with high-risk situations for smoking relapse. Measurements and Main Results: One year after myocardial infarction, the smoking cessation rate, verified biochemically, was 71% in the intervention group compared with 45% in the usual care group, a 26% difference (95% CI, 9.5% to 42.6%). Assuming that all surviving patients lost to follow-up were smoking, the 12-month smoking cessation rate was 61% in the intervention group compared with 32% in the usual care group, a 29% difference (95% CI, 14.5% to 43.5%). Patients who either resumed smoking within 3 weeks after infarction or expressed little intention of stopping in the hospital were unlikely to have stopped by 12 months. Conclusions: A nurse-managed smoking cessation intervention largely conducted by telephone, initiated in the hospital, and focused on relapse prevention can significantly reduce smoking rates at 12 months in patients who have had a myocardial infarction.