Abstract
Objective:To determine the impact of an episode of serious cardiovascular disease on smoking behavior and to identify factors associated with smoking cessation in this setting.
Design:Prospective observational study in which smokers admitted to a coronary care unit (CCU) were followed for one year after hospital discharge to determine subsequent smoking behavior.
Setting:Coronary care unit of a teaching hospital.
Patients:Preadmission smoking status was assessed in all 828 patients admitted to the CCU during one year. The 310 smokers surviving to hospital discharge were followed and their smoking behaviors assessed by self-report at six and 12 months.
Intervention:None.
Measurements and main results:Six months after discharge, 32% of survivors were not smoking; the rate of sustained cessation at one year was 25%. Smokers with a new diagnosis of coronary heart disease (CHD) made during hospitalization had the highest cessation rate (53% vs. 31%, p=0.01). On multivariate analysis, smoking cessation was more likely if patients were discharged with a diagnosis of CHD, had no prior history of CHD, were lighter smokers (<1 pack/day), and had congestive heart failure during hospitalization. Among smokers admitted because of suspected myocardial infarction (MI), cessation was more likely if the diagnosis was CHD than if it was noncoronary (37% vs. 19%, p<0.05), but a diagnosis of MI led to no more smoking cessation than did coronary insufficiency.
Conclusion:Hospitalization in a CCU is a stimulus to long-term smoking cessation, especially for lighter smokers and those with a new diagnosis of CHD. Admission to a CCU may represent a time when smoking habits are particularly susceptible to intervention. Smoking cessation in this setting should improve patient outcomes because cessation reduces cardiovascular mortality, even when quitting occurs after the onset of CHD.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
U.S. Department of Health and Human Services. Reducing the health consequences of smoking: 25 years of progress. A report of the Surgeon General. DHHS (PHS) Publication No. (CDC) 89-8411. Washington, DC: Government Printing Office, 1989.
Garvey AJ, Bosse R, Glynn RJ, Rosner B. Smoking cessation in a prospective study of healthy adult males: effects of age, time period, and amount smoked. Am J Public Health. 1983;73:446–50.
Benfari RC, Ockene JK, McIntyre KM. Control of cigarette smoking from a psychological perspective. Ann Rev Public Health. 1982;3:101–28.
Leventhal H, Cleary PD. The smoking problem: a review of the research and theory in behavioral risk modification. Psychol Bull. 1980;88:370–405.
Perkins KA. Maintaining smoking abstinence after myocardial infarction. J Subst Abuse. 1988;1:91–107.
Schwartz JL. Review and evaluation of smoking cessation methods: the United States and Canada, 1979–1985. Bethesda, MD: U.S. Department of Health and Human Services, 1987. NIH publication No 87-2940.
Sparrow D, Dawber RR, Colton T. The influence of cigarette smoking on prognosis after a first myocardial infarction. J Chron Dis. 1978;31:425–532.
Burt A, Thornley R, Illingworth D, White P, Shaw TRD, Turner R. Stopping smoking after myocardial infarction. Lancet. 1974;1:304–6.
Weinblatt E, Shapiro S, Frank CW. Changes in personal characteristics of men over five years following first diagnosis of coronary heart disease. Am J Public Health. 1971;61:831–42.
Hay DR, Turbott S. Changes in smoking habits in men under 65 years after myocardial infarction and coronary insufficiency. Br Heart J. 1970;32:738–40.
Mallaghan M, Pemberton J. Some behavioral changes in 493 patients after an acute myocardial infarction. Br J Prev Soc Med. 1977;31:86–90.
Croog SH, Richards NP. Health beliefs and smoking patterns in heart patients and their wives: a longitudinal study. Am J Public Health. 1977;67:921–30.
Wilhelmsson C, Ehnfeldt D, Vedin JA, Elmheldt D, Tibblin G. Smoking and myocardial infarction. Lancet. 1975;1:415–9.
Daly LE, Mulcahy R, Graham IM, Hickey N. Long-term effect on mortality of stopping smoking after unstable angina and myocardial infarction. Br Med J. 1983;287:324–6.
Kannel WB, Castelli WP. Latest perspective on cigarette smoking in cardiovascular disease: the Framingham study. J Am Coll Cardiol. 1983;1:601.
Johanson S, Bergstrand R, Pennart K, et al. Cessation of smoking after myocardial infarction in women: effects on mortality and reinfarction. Am J Epidemiol. 1985;121:823–31.
Thibault GE, Mulley AG, Barnett GO, et al. Medical intensive care: indications, interventions, and outcomes. N Engl J Med. 1980;302:938–42.
BMDPLR—logistic regression. BMDP Statistical Software, Inc. Los Angeles: University of California, 1982.
U.S. Department of Health and Human Services. The health benefits of smoking cessation. DHHS Publication No. (CDC) 90-8416. Washington, DC: Government Printing Office, 1990;37–46.
Becker MH, Maiman LA. Sociobehavioral determinants of compliance with health and medical care recommendations. Med Care. 1975;13:10–24.
Ockene JK, Hymowitz N, Sexton M, Broste SK. Comparison of patterns of smoking behavior change among smokers in the Multiple Risk Factor Intervention Trial (MRFIT). Prev Med. 1982;11:621–38.
Rose G, Hamilton PJS. A randomized controlled trial of the effect on middle-aged men of advice to stop smoking. J Epidemiol Community Health. 1978;32:275–81.
Cutter G, Oberman MK, Kimmerling R, Obermen A. The natural history of smoking cessation among patients undergoing coronary arteriography. J Cardiopulmonary Rehabil. 1985;5:332–40.
Baile WF Jr, Bigelow GE, Gottlieb SH, Stizer ML, Sacktor JD. Rapid resumption of cigarette smoking following myocardial infarction: inverse relation to MI severity. Addict Behav. 1982;7:373–80.
Havik OE, Maeland JG. Changes in smoking behavior after myocardial infarction. Health Psychol. 1988;7:403–20.
Ockene JK, Hosmer D, Rippe J, et al. Factors affecting cigarette smoking status in patients with ischemic heart disease. J Chron Dis. 1985;38:985–94.
Scott RR, Lamparski D. Variables related to long-term smoking status following cardiac events. Addict Behav. 1985;10:257–64.
Taylor CB, Houston-Miller N, Killen JD, DeBusk RF. Smoking cessation after acute myocardial infarction: effects of a nurse-managed intervention. Ann Intern Med. 1990;113:118–23.
Rigotti NA, McKool K. Smoking cessation after coronary artery bypass surgery: randomized trial of an in-hospital intervention. Clin Res. 1990;38:741A.
Fiore MC, Novotny TE, Pierce JP, et al. Methods used to quit smoking in the United States: do cessation programs help? JAMA. 1990;263:2760–5.
Taylor CB, Houston-Miller N, Haskell WL, DeBusk RF. Smoking cessation after acute myocardial infarction: the effects of exercise training. Addict Behav. 1988;13:331–5.
Conroy R, Mulcahy R, Graham IM, Reid V, Cahill S. Predictors of patient response to risk-factor modification advice after admission for unstable angina or myocardial infarction. J Cardiopulmonary Rehabil. 1986;6:344–57.
Author information
Authors and Affiliations
Additional information
Received from the General Internal Medicine Unit, Medical Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. Dr. Rigotti is a Teaching and Research Scholar of the American College of Physicians. Dr. Thibault is now Chief of Medicine, Brockton/West Roxbury Veterans Affairs Medical Center.
Rights and permissions
About this article
Cite this article
Rigotti, N.A., Singer, D.E., Mulley, A.G. et al. Smoking cessation following admission to a coronary care unit. J Gen Intern Med 6, 305–311 (1991). https://doi.org/10.1007/BF02597426
Issue Date:
DOI: https://doi.org/10.1007/BF02597426