"Smoking is the greatest risk factor for patients with heart disease," said author Syed M. Mohiuddin, MD, FCCP, Creighton University Cardiac Center, Omaha, NE, "and our study showed that intense treatment intervention not only succeeded in getting patients to quit smoking, but it reduced hospitalizations and mortality, as well." From January 2001 to December 2002, Dr. Mohiuddin and colleagues gathered 209 patients who were admitted to the coronary care unit at the Creighton University Cardiac Center, suffering from unstable angina, heart attack, or severe coronary heart disease. All of the patients were self-identified smokers and agreed to undergo smoking cessation intervention. Patients were then randomized into two groups: the intensive intervention group (109) and the usual care group (100). Prior to hospital discharge, all patients received approximately 30 minutes of counseling and were given self-help materials. Treatment in the intervention group also included a minimum 12 weeks of behavior modification counseling, coupled with individualized pharmacotherapy. This included nicotine replacement therapy and/or bupropion at no cost to the patient. However, patients in the usual care group did not receive anything beyond the initial inpatient counseling session. "The intensive component of tobacco cessation therapy was started while patients were hospitalized but continued after release," said Dr. Mohiuddin, "making the outpatient portion of this program the most significant element." All participants returned at 3, 6, 12, and 24 months, during which follow- up medical histories and expired carbon monoxide levels were obtained. Patients who reported having not smoked during the previous evaluation period and who were confirmed by a negative expired carbon monoxide were classified as "abstinent." Those patients who were confirmed as not smoking by their expired carbon monoxide at every visit were classified as "continuously abstinent." Compared with the usual care group, patients in the intensive treatment group had significantly higher quit rates at all follow-up time intervals. At the two-year follow-up, 39 percent of the intensive treatment group was continuously abstinent, compared with only 9 percent of the usual care group. Additionally, treatment was shown to reduce the risk of hospitalization by nearly half. Researchers also found that those in the control group were four times as likely to die than were patients in the intervention group. "Cessation of smoking results in an almost immediate improvement in the risk of heart attack," said Dr. Mohiuddin, "and our study proves that intense smoking cessation treatment in high-risk patients is successful and that it saves lives." "Smoking clearly links patients with cardiovascular disease to adverse outcomes," said Mark J. Rosen, MD, FCCP, President of the American College of Chest Physicians. "It's never too late to quit smoking and all patients who smoke should work with their doctors to find the quit method that works best for them." CHEST is a peer-reviewed journal published by the ACCP. It is available online each month at

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