scholarly journals Improving smoking cessation after myocardial infarction by systematically implementing evidence-based treatment methods

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Margret Leosdottir ◽  
Sanne Wärjerstam ◽  
Halldora Ögmundsdottir Michelsen ◽  
Mona Schlyter ◽  
Emma Hag ◽  
...  

AbstractWe compared the odds of smoking cessation at 2-months post-myocardial infarction (MI), before and after implementing routines optimizing use of evidence-based smoking cessation methods, with start during admission. The following routines were implemented at six Swedish hospitals: cardiac rehabilitation nurses offering smokers consultation during admission, optimizing nicotine replacement therapy and varenicline prescription, and contacting patients by telephone during the 1st week post-discharge. Using logistic regression, odds for smoking cessation at 2-months before (n smokers/n admitted = 188/601) and after (n = 195/632) routine implementation were compared. Secondary outcomes included adherence to implemented routines and assessing the prognostic value of each routine on smoking cessation. After implementation, a larger proportion of smokers (65% vs. 54%) were abstinent at 2-months (OR 1.60 [1.04–2.48]). Including only those counselled during admission (n = 98), 74% were abstinent (2.50 [1.42–4.41]). After implementation, patients were more often counselled during admission (50% vs. 6%, p < 0.001), prescribed varenicline (23% vs. 7%, p < 0.001), and contacted by telephone post-discharge (18% vs. 2%, p < 0.001). Being contacted by telephone post-discharge (adjusted OR 2.74 [1.02–7.35]) and prescribed varenicline (adjusted OR 0.39 [0.19–0.83]) predicted smoking cessation at 2-months. In conclusion, readily available methods for aiding smoking cessation can be implemented effectively in routine practice, with beneficial effects for post-MI patients.

2021 ◽  
Author(s):  
Margret Leosdottir ◽  
Sanne Wärjerstam ◽  
Halldora Michelsen ◽  
Mona Schlyter ◽  
Emma Hag ◽  
...  

Abstract We compared the odds of smoking cessation at 2-months post-myocardial infarction (MI) before and after implementing routines, optimizing the use of evidence-based methods for smoking cessation, with start during admission. The following routines were implemented at six hospitals in Sweden: cardiac rehabilitation nurses offering smokers short consultation during admission, optimizing nicotine replacement therapy, increasing prescription of varenicline, and contacting patients by telephone during the 1st week post-discharge. Using logistic regression, odds for smoking cessation at 2-months post-MI before (n = 188) and after (n = 195) routine implementation were compared. Secondary outcomes included adherence to implemented routines. After implementation, a larger proportion of patients (65% vs 54%) were abstinent at 2-months (OR 1.60 [1.04–2.48], p = 0.034). Including only those counselled during admission, 74% were abstinent (OR 2.50 [1.42–4.41], p = 0.002). After implementation patients were more often counselled during admission (50% vs 6%, p < 0.001), prescribed varenicline (23% vs 7%, p < 0.001), and contacted by telephone post-discharge (18% vs 2%, p < 0.001). Being prescribed varenicline had the strongest association with smoking abstinence at 2-months (adjusted OR 4.09 [1.68-10.00], p = 0.002). In conclusion, readily available methods for aiding smoking cessation can be implemented effectively in routine practice, with beneficial effects on smoking cessation for the high-risk group of smoking MI patients.


2021 ◽  
Author(s):  
Margret Leosdottir ◽  
Sanne Wärjerstam ◽  
Halldora Ögmundsdottir Michelsen ◽  
Mona Schlyter ◽  
Emma Hag ◽  
...  

Abstract Background: Evidence-based methods for aiding smoking cessation post-myocardial infarction are effective yet underused in clinical practice. We compared the odds of smoking cessation at 2-months post-myocardial infarction before versus after implementing a set of pre-specified routines optimizing evidence-based treatment methods for smoking cessation, initiated during admission. Methods: Structured routines for early smoking cessation counselling and treatment optimization were implemented at six cardiac rehabilitation centres in Sweden. The routines included cardiac rehabilitation nurses providing current smokers hospitalized for acute myocardial infarction with short consultation, written material, and optimal dosage of nicotine replacement therapy during admission, increasing early prescription of varenicline for eligible patients, and contacting the patients by telephone 3-5 days after discharge, after which usual care follow-up commenced. Centres were also encouraged to strive for continuity in nurse-patient care. Using logistic regression, we compared the odds for smoking cessation at 2-months post-discharge for currently smoking patients admitted (a) before (n=188, median age 60 years, 23% females) and (b) after (n=195, median age 60 years, 29% females) routine implementation. Secondary outcomes included adherence to implemented routines and the association of each routine with smoking cessation odds at 2-months.Results: In total, 159 (85%) and 179 (92%) of enrolled patients attended the 2-month follow-up, before and after implementation of the new routines. After implementation, a significantly larger proportion of patients (65% vs 54%) were abstinent from smoking at 2-months (OR 1.60 [1.04-2.48], p=0.034). Including only those counselled during admission (n=89), 74% (vs 54%) were abstinent at 2-months (OR 2.50 [1.42-4.41], p=0.002). After the new routine implementation patients were counselled more frequently during admission (50% vs 6%, p<0.001), prescribed varenicline at discharge or during follow-up (23% vs 7%, p<0.001), and contacted by telephone during the first week post-discharge (18% vs 2%, p<0.001), compared to before. Being prescribed varenicline before discharge or during follow-up had the strongest independent association with smoking abstinence at 2-months (adjusted OR 4.09 [1.68-10.00], p=0.002).Conclusions: Our results support that readily available methods for aiding smoking cessation can be implemented effectively in routine practice, with possible beneficial effects on smoking cessation for the high-risk group of smoking myocardial infarction patients.


2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Leosdottir ◽  
S Warjerstam ◽  
H Ogmundsdottir Michelsen ◽  
M Schlyter ◽  
E Hag ◽  
...  

Abstract Background For smokers who suffer a myocardial infarction (MI), smoking cessation is the most effective measure to reduce recurrent event risk. Still, evidence-based treatment methods for aiding smoking cessation post-MI are underused. Purpose To compare the odds of smoking cessation at two-months post-MI before and after implementing a set of pre-specified routines for optimization of evidence-based treatment methods for smoking cessation, with start during admission. Methods Structured routines for early smoking cessation counselling and treatment optimization were implemented at six cardiac rehabilitation (CR) centres in Sweden. The routines included CR nurses providing current smokers hospitalized for acute MI with short consultation, written material, and optimal dosage of nicotine replacement therapy during admission, increasing early prescription of varenicline for eligible patients, and contacting the patients by telephone 3–5 days after discharge, after which usual care CR follow-up commenced. Centres were also encouraged to strive for continuity in nurse-patient care. Patient data was retrieved from the SWEDEHEART registry and medical records. Using logistic regression, we compared the odds for smoking cessation at two-months post-MI for currently smoking patients admitted with MI (a) before (n=188, median age 60 years, 23% females) and (b) after (n=195, median age 60 years, 29% females) routine implementation. Secondary outcomes included adherence to implemented routines and the association of each routine with smoking cessation odds at two-months. Results In total, 159 (85%) and 179 (92%) of enrolled patients attended the two-month CR follow-up, before and after implementation of the new routines. After implementation, a significantly larger proportion of patients (65% vs 54%) were abstinent from smoking at two-months (crude OR 1.60 [1.04–2.48], p=0.034) (Figure 1). Including only those counselled during admission (n=89), 74% (vs 54%) were abstinent at two-months (crude OR 2.50 [1.42–4.41], p=0.002). After the new routine implementation patients were counselled more frequently during admission (50% vs 6%, p&lt;0.001), prescribed varenicline at discharge or during follow-up (23% vs 7%, p&lt;0.001), and contacted by telephone during the first week post-discharge (18% vs 2%, p&lt;0.001), compared to before implementation. Crude and adjusted associations between each routine and smoking cessation at two-months are shown in Table 1. Entering all routines into the regression model simultaneously, being prescribed varenicline before discharge or during follow-up had the strongest independent association with smoking abstinence at two-months (adjusted OR 4.09 [1.68–10.00], p=0.002). Conclusion Our results support that readily available methods for aiding smoking cessation can be implemented effectively in routine practice, with possible beneficial effects on smoking cessation for the high-risk group of smoking MI patients. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): The Swedish Heart and Lung AssociationPfizer AB


2018 ◽  
Vol 260 ◽  
pp. 1-6 ◽  
Author(s):  
Belén Alvarez-Alvarez ◽  
Charigan Abou Jokh Casas ◽  
Jose María Garcia Acuña ◽  
Belén Cid Alvarez ◽  
Rosa María Agra Bermejo ◽  
...  

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Marjorie E Zettler ◽  
Eric D Peterson ◽  
Lisa A McCoy ◽  
Mark B Effron ◽  
Kevin J Anstrom ◽  
...  

Background: With the availability of several ADP receptor inhibitors (ADPri), switching between agents is known to occur. However, among myocardial infarction (MI) patients treated with percutaneous coronary intervention (PCI), the incidence and patterns of post-discharge ADPri switching are unknown. Methods: Using data from the TRANSLATE-ACS study (2010-2012), we assessed the incidence of post-discharge ADPri switching among 8672 MI patients who were discharged after PCI and remained on ADPri therapy through 1 year post-MI. We examined bleeding and major adverse cardiovascular events (MACE: MI, stroke, unplanned revascularization) within 7 days before and after switching. Results: During the first year after index MI discharge, 663 patients (7.6%) had a switch in ADPri; switching occurred at a median of 50 days (IQR 7-154) post-discharge. Switching occurred most frequently in patients discharged on ticagrelor (64/226, 28.3%), then prasugrel (383/2489, 15.4%), and clopidogrel (216/5957, 3.6%, p<0.001). Among patients discharged on prasugrel, 97.3% of switches were to clopidogrel; 87.5% of ticagrelor switches were to clopidogrel. Among clopidogrel patients who switched, 55 (25.5%) had a MACE event in the 7 days preceding switch. Among prasugrel and ticagrelor patients who switched, a GUSTO moderate/severe bleeding event occurred in 5 (1.3%) and 1 (1.5%) patients, respectively, in the 7 days preceding switch. Patients switched from prasugrel or ticagrelor most often cited cost as a reason for the switch (43.6% and 39.1%, respectively), while 60.7% of patients switched from clopidogrel attributed the switch to a physician decision. In the week following a switch, both MACE and major bleeding events were infrequent (table). Conclusions: ADPri switching occurred infrequently within the first year post-MI. Switching occurred more commonly among patients discharged on higher potency ADPri, but only a minority of these switches were triggered by bleeding.


2013 ◽  
Vol 34 (suppl 1) ◽  
pp. 809-809
Author(s):  
S. M. Sollien Berger ◽  
M. Schou ◽  
M. D. Schmiegelow ◽  
A. K. Nume ◽  
S. Christensen ◽  
...  

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