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Recommendation
| Realize that smoking cessation is associated with dramatic reduction in mortality rates and other adverse outcomes in patients with previous myocardial infarction or documented coronary artery disease.
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Evidence:
- A meta-analysis of 12 cohort studies of the effect of smoking cessation after myocardial infarction found the combined OR for death in patients who quit was 0.54, equivalent to a number needed to treat of 13 (8).
- Similar mortality benefits have been seen in persons who quit smoking after coronary artery bypass surgery, after coronary angioplasty, and among patients with angiographically documented coronary stenosis (9; 10; 11; 12).
- A cohort study of patients post myocardial infarction found that mortality among patients who quit smoking post infarct approached that of nonsmokers within 3 years (13).
- A randomized trial showed that an intensive smoking cessation intervention targeting smokers hospitalized with acute cardiovascular disease increased abstinence rates (33% intervention vs. 9% usual care) and over a 2-year follow-up period reduced hospitalizations and all-cause mortality (2.8% intervention vs. 12.0% usual care, absolute risk reduction 9.2%, NNT=11) (14).
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Comments:
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| Edward Ellerbeck, MD, MPH, editorial consultant, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Kumanan Wilson, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Steven E. Weinberger, MD, FACP, Acting Editor, PIER, has stock holdings in Glaxosmithkline and Abbott. |
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Smoking Cessation
> Effectiveness/Harms of Behavior Change on Clinical Outcomes
