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.