Intense Cessation Treatment Proves Successful In High-Risk Smokers
Hospitalized patients who
undergo structured treatment to quit smoking are significantly more likely
to remain smoke-free, says a new study. New research published in the
February issue of CHEST, the peer-reviewed journal of the American College
"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
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
"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