Efficacy of psychosocial interventions for smoking cessation in patients with coronary heart disease: a systematic review and meta-analysis

Background: Quitting smoking improves prognosis after a cardiac event. Therefore smoking cessation is highly recommended for patients with coronary heart disease (CHD), but many patients continue to smoke, and improved cessation aids are urgently required.Purpose: The objective was to conduct a systematic review of the efficacy of psychosocial interventions to quit smoking in patients with CHD.Methods: Seven electronic databases were searched from the start of the database to August 2003. Search terms were coronary or cardio or heart or cvd or chd and smok* and cessation or absti*. Results were supplemented by cross-checking references. More than 2,000 papers were screened in a first step. Eligibility of studies was assessed (by reviewer Jürgen Barth) and reasons for exclusion were coded. Abstinence rates were computed both according to an intention to treat analysis, and based on follow-up results only.Results:We found 19 randomized controlled trials, comparing a specific psychosocial intervention with “usual care,” with a minimum of 6-month follow-up. Interventions consist of behavioral therapeutic approaches, telephone support, and self-help material. The trials mostly included older male patients with CHD, predominantly myocardial infarction. Overall results found a positive effect of interventions on abstinence after 6 to 12 months (OR = 1.66, 95% CI = 1.24–2.21), but substantial heterogeneity between trials. Clustering the trials by type of intervention reduced heterogeneity, although many trials used more than one type of intervention. Trials involving behavioral therapies or telephone contact were little different from self-help techniques (OR = 1.65, 95% CI = 1.28–2.13 for behavioral therapies; OR = 1.58, 95% CI = 1.26–1.98 for telephone sup support; OR = 1.47, 95% CI = 1.10–1.97 for self-help). Treatment intensity was associated with study outcome. More intense interventions showed increased quit rates (OR = 1.95, 95% CI = 1.61–2.35) whereas interventions of low intensity did not appear effective (OR = 0.92, 95% CI = 0.70–1.22). Studies with validated assessment of smoking status at follow-up had lower efficacy than nonvalidated trials.Conclusions: Smoking cessation interventions are effective in promoting abstinence up to 1 year, provided they are of sufficient intensity with a minimum length of 1 month. Further studies should compare different psychosocial intervention strategies, or the combination of a psychosocial intervention strategy with nicotine replacement therapy or bupropion compared with nicotine replacement or bupropion alone.

[1]  M. Munafo,et al.  Interventions for smoking cessation in hospitalised patients. , 2007, The Cochrane database of systematic reviews.

[2]  J. Barth,et al.  Smoking Cessation in Patients With Coronary Heart Disease: Risk Reduction and an Evaluation of the Efficacy of Interventions. , 2007 .

[3]  L. Stead,et al.  Self-help interventions for smoking cessation. , 2005, The Cochrane database of systematic reviews.

[4]  R. Hurt,et al.  High dose transdermal nicotine therapy for heavy smokers: safety, tolerability and measurement of nicotine and cotinine levels , 1995, Psychopharmacology.

[5]  A. Hoes,et al.  [Guidelines on cardiovascular disease prevention in clinical practice]. , 2005, Revue medicale de Liege.

[6]  D. Mant,et al.  Nicotine replacement therapy for smoking cessation. , 2005, The Cochrane database of systematic reviews.

[7]  C. Herrmann-Lingen,et al.  Depression as a Risk Factor for Mortality in Patients With Coronary Heart Disease: A Meta-analysis , 2004, Psychosomatic medicine.

[8]  J. Ockene,et al.  A primer on current evidence-based review systems and their implications for behavioral medicine , 2004, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[9]  M. Vanpoppel,et al.  Stage-based lifestyle interventions in primary care: are they effective? , 2004 .

[10]  W. Mechelen,et al.  Stage-based lifestyle interventions in primary care: are they effective? , 2004 .

[11]  Dan Tzivoni,et al.  Cardiovascular Safety of Transdermal Nicotine Patches in Patients with Coronary Artery Disease who Try to Quit Smoking , 1998, Cardiovascular Drugs and Therapy.

[12]  Wayne F Velicer,et al.  A comparison of four self-report smoking cessation outcome measures. , 2004, Addictive behaviors.

[13]  L. Stead,et al.  Physician advice for smoking cessation. , 2004, The Cochrane database of systematic reviews.

[14]  P. Quist-Paulsen,et al.  Randomised controlled trial of smoking cessation intervention after admission for coronary heart disease , 2003, BMJ : British Medical Journal.

[15]  R. Peters,et al.  Smoking cessation interventions in cardiovascular patients. , 2003, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[16]  D. Altman,et al.  Measuring inconsistency in meta-analyses , 2003, BMJ : British Medical Journal.

[17]  Shah Ebrahim,et al.  European guidelines on cardiovascular disease prevention in clinical practice. Third Joint Task Force of European and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. , 2003 .

[18]  J. Critchley,et al.  Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review. , 2003, JAMA.

[19]  I Campbell,et al.  Nicotine replacement therapy in smoking cessation. , 2003, Thorax.

[20]  A. Sowden,et al.  Systematic review of the effectiveness of stage based interventions to promote smoking cessation , 2003, BMJ : British Medical Journal.

[21]  S. Fu,et al.  Safety issues in pharmacotherapy for smoking in patients with cardiovascular disease. , 2003, Progress in cardiovascular diseases.

[22]  A. Pipe,et al.  Stepped care approach to smoking cessation in patients hospitalized for coronary artery disease. , 2003, Journal of cardiopulmonary rehabilitation.

[23]  S. Tonstad,et al.  Bupropion SR for smoking cessation in smokers with cardiovascular disease: a multicentre, randomised study. , 2003, European heart journal.

[24]  C. V. van Schayck,et al.  Smoking cessation for chronic obstructive pulmonary disease. , 2003, The Cochrane database of systematic reviews.

[25]  L. Wulsin,et al.  Do depressive symptoms increase the risk for the onset of coronary disease? A systematic quantitative review. , 2003, Psychosomatic medicine.

[26]  L. Stead,et al.  Individual behavioural counselling for smoking cessation. , 2017, The Cochrane database of systematic reviews.

[27]  H. Handoll,et al.  Interventions for replacing missing teeth: different times for loading dental implants. , 2004, The Cochrane database of systematic reviews.

[28]  Kenneth F Schulz,et al.  Allocation concealment in randomised trials: defending against deciphering , 2002, The Lancet.

[29]  Kenneth F Schulz,et al.  Generation of allocation sequences in randomised trials: chance, not choice , 2002, The Lancet.

[30]  G. V. van Breukelen,et al.  Evaluation of a nurse-managed minimal-contact smoking cessation intervention for cardiac inpatients. , 2002, Health education research.

[31]  P. Mills,et al.  Brief intervention during hospital admission to help patients to give up smoking after myocardial infarction and bypass surgery: randomised controlled trial , 2002, BMJ : British Medical Journal.

[32]  Johan P Mackenbach,et al.  Income inequality and population health , 2002, BMJ : British Medical Journal.

[33]  R. Young,et al.  Randomized controlled trial of two cigarette quit programmes in coronary care patients after acute myocardial infarction , 2001, Internal medicine journal.

[34]  H. McRobbie,et al.  Nicotine replacement therapy in patients with cardiovascular disease: guidelines for health professionals. , 2001, Addiction.

[35]  M. Holmes-Rovner,et al.  Cardiac rehabilitation for community-based patients with myocardial infarction: factors predicting discharge recommendation and participation. , 2001, Journal of clinical epidemiology.

[36]  D. Hedeker,et al.  Statistical analysis of randomized trials in tobacco treatment: longitudinal designs with dichotomous outcome. , 2001, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[37]  Douglas G Altman,et al.  Systematic reviews of evaluations of prognostic variables , 2001, BMJ : British Medical Journal.

[38]  Douglas G Altman,et al.  Systematic reviews in health care: Assessing the quality of controlled clinical trials. , 2001, BMJ.

[39]  J. Tanus-Santos,et al.  Cardiovascular effects of transdermal nicotine in mildly hypertensive smokers. , 2001, American journal of hypertension.

[40]  S. Gardner,et al.  New Recommendations from the 1999 American College of Cardiology/American Heart Association Acute Myocardial Infarction Guidelines , 2001, The Annals of pharmacotherapy.

[41]  R. Perera,et al.  Telephone counselling for smoking cessation. , 2003, The Cochrane database of systematic reviews.

[42]  R. Perera,et al.  Nicotine replacement therapy for smoking cessation. , 2012, The Cochrane database of systematic reviews.

[43]  D. Cook,et al.  Effect of smoking cessation on mortality after myocardial infarction: meta-analysis of cohort studies. , 2000, Archives of internal medicine.

[44]  P. Thompson,et al.  A randomized controlled trial of smoking cessation counseling after myocardial infarction. , 2000, Preventive medicine.

[45]  M. Díaz,et al.  Eficacia de una intervención para dejar de fumar en pacientes con infarto de miocardio , 2000 .

[46]  J R Hughes,et al.  Antidepressants for smoking cessation. , 2007, The Cochrane database of systematic reviews.

[47]  L. Stead,et al.  Group behaviour therapy programmes for smoking cessation. , 2000, The Cochrane database of systematic reviews.

[48]  D. Mant,et al.  General practice Randomised controlled trial of follow up care in general practice of patients with myocardial infarction and angina : final results of the Southampton heart integrated care project ( SHIP ) , 1999 .

[49]  J. Schmitz,et al.  Smoking cessation in women with cardiac risk: a comparative study of two theoretically based therapies. , 1999, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[50]  A. Öhman,et al.  Behavioral effects of a comprehensive, multifactorial program for lifestyle change after percutaneous transluminal coronary angioplasty: a prospective, randomized controlled study. , 1999, Journal of psychosomatic research.

[51]  J. Ockene,et al.  Coronary Artery Smoking Intervention Study (CASIS): 5-year follow-up. , 1998, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[52]  A. Döring,et al.  Classical risk factors and their impact on incident non-fatal and fatal myocardial infarction and all-cause mortality in southern Germany. Results from the MONICA Augsburg cohort study 1984-1992. Monitoring Trends and Determinants in Cardiovascular Diseases. , 1998, European heart journal.

[53]  N. Campbell,et al.  Secondary prevention clinics for coronary heart disease: randomised trial of effect on health , 1998, BMJ.

[54]  I. Ockene,et al.  Cigarette smoking, cardiovascular disease, and stroke: a statement for healthcare professionals from the American Heart Association. American Heart Association Task Force on Risk Reduction. , 1997, Circulation.

[55]  M. Woodward,et al.  Comparison of the prediction by 27 different factors of coronary heart disease and death in men and women of the Scottish heart health study: cohort study , 1997, BMJ.

[56]  S. Rollnick,et al.  Helping smokers make decisions: the enhancement of brief intervention for general medical practice. , 1997, Patient education and counseling.

[57]  N. Benowitz,et al.  Cardiovascular toxicity of nicotine: implications for nicotine replacement therapy. , 1997, Journal of the American College of Cardiology.

[58]  G. Lindberg,et al.  Influence of coronary nursing management follow up on lifestyle after acute myocardial infarction. , 1997, Heart.

[59]  Michael W. Green,et al.  Annals of Behavioral Medicine , 1997 .

[60]  B. Steele,et al.  The safety of transdermal nicotine as an aid to smoking cessation in patients with cardiac disease. , 1996, The New England journal of medicine.

[61]  L. Hillis,et al.  Intranasal nicotine spray does not augment the adverse effects of cigarette smoking on myocardial oxygen demand or coronary arterial dimensions. , 1996, The American journal of medicine.

[62]  J. Allen,et al.  Coronary risk factor modification in women after coronary artery bypass surgery. , 1996, Nursing research.

[63]  I. Olkin,et al.  Improving the quality of reporting of randomized controlled trials. The CONSORT statement. , 1996, JAMA.

[64]  Timothy B. Baker,et al.  The Effectiveness of the Nicotine Patch for Smoking Cessation. A Meta-analysis , 1995 .

[65]  J. Ottervanger,et al.  Acute myocardial infarction while using the nicotine patch. , 1995, Chest.

[66]  S. Maes,et al.  Effects of a health education programme with telephone follow-up during cardiac rehabilitation. , 1994, The British journal of clinical psychology.

[67]  Diane C. Thompson,et al.  The validity of self-reported smoking: a review and meta-analysis. , 1994, American journal of public health.

[68]  M. Fiore,et al.  The effectiveness of the nicotine patch for smoking cessation. A meta-analysis. , 1994, JAMA.

[69]  S. Maes,et al.  Effects of a post-hospitalization group health education programme for patients with coronary heart disease. , 1994, Psychology & health.

[70]  C. Dennis,et al.  A Case-Management System for Coronary Risk Factor Modification after Acute Myocardial Infarction , 1994, Annals of Internal Medicine.

[71]  R. Krauss,et al.  Effects of intensive multiple risk factor reduction on coronary atherosclerosis and clinical cardiac events in men and women with coronary artery disease. The Stanford Coronary Risk Intervention Project (SCRIP). , 1994, Circulation.

[72]  S. Shiffman,et al.  Predictors of Smoking Cessation after Coronary Artery Bypass Graft Surgery: Results of a Randomized Trial with 5-Year Follow-up , 1994, Annals of Internal Medicine.

[73]  P. Norman,et al.  Causal attributions, health locus of control beliefs and lifestyle changes among pre-operative coronary patients. , 1992 .

[74]  H. Hämäläinen,et al.  Coronary heart disease risk factors before and after bypass surgery: results of a controlled trial on multifactorial rehabilitation. , 1992, European heart journal.

[75]  M. Woodward,et al.  Biochemical evidence of persistent heavy smoking after a coronary diagnosis despite self-reported reduction: analysis from the Scottish Heart Health Study. , 1992, European heart journal.

[76]  D. Hosmer,et al.  Smoking cessation and severity of disease: the Coronary Artery Smoking Intervention Study. , 1992, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[77]  D. Sideris,et al.  Effects of group psychosocial intervention on coronary risk factors. , 1992, Psychotherapy and psychosomatics.

[78]  W F Velicer,et al.  Assessing outcome in smoking cessation studies. , 1992, Psychological bulletin.

[79]  B. Fridlund,et al.  Recovery after myocardial infarction. Effects of a caring rehabilitation programme. , 1991, Scandinavian journal of caring sciences.

[80]  C. Taylor,et al.  Smoking cessation after acute myocardial infarction: effects of a nurse-managed intervention. , 1990, Annals of internal medicine.

[81]  W. Willett,et al.  Relative and absolute excess risks of coronary heart disease among women who smoke cigarettes. , 1987, The New England journal of medicine.

[82]  B. Hedbäck,et al.  5-year results of a comprehensive rehabilitation programme after myocardial infarction. , 1987, European heart journal.

[83]  S. Johansson,et al.  Cessation of smoking after myocardial infarction. Effects on mortality after 10 years. , 1983, British heart journal.

[84]  K. Newton,et al.  Limited effects of outpatient teaching and counseling after myocardial infarction: a controlled study. , 1983, Heart & lung : the journal of critical care.

[85]  C. Kallman,et al.  Early discharge following acute myocardial infarction. Long-term follow-up of randomized patients. , 1982, Archives of internal medicine.

[86]  P. Thornley,et al.  Hospital Practice: STOPPING SMOKING AFTER MYOCARDIAL INFARCTION , 1974 .

[87]  P. Thornley,et al.  Stopping smoking after myocardial infarction. , 1974, Lancet.

[88]  D. Pyke,et al.  Letter: Metronidazole and iron in cancer therapy. , 1947 .