scholarly journals Improving Smoking Cessation After Myocardial Infarction by Systematically Implementing Evidence-Based Treatment Methods: A Retrospective Observational Cohort Study

2021 ◽  
Author(s):  
Margret Leosdottir ◽  
Sanne Wärjerstam ◽  
Halldora Ögmundsdottir Michelsen ◽  
Mona Schlyter ◽  
Emma Hag ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Smoking Cessation ◽  
Cardiac Rehabilitation ◽  
Post Myocardial Infarction ◽  
Optimal Dosage ◽  
Evidence Based ◽  
Post Discharge ◽  
Treatment Methods ◽  
Evidence Based Treatment

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.

scholarly journals Improving smoking cessation after myocardial infarction by systematically implementing evidence-based treatment methods: a prospective observational cohort study

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Leosdottir ◽  
S Warjerstam ◽  
H Ogmundsdottir Michelsen ◽  
M Schlyter ◽  
E Hag ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Smoking Cessation ◽  
Recurrent Event ◽  
Optimal Dosage ◽  
Evidence Based ◽  
Effective Measure ◽  
Treatment Methods ◽  
Evidence Based Treatment ◽  
Before And After

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

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 ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Smoking Cessation ◽  
Prognostic Value ◽  
Routine Practice ◽  
Evidence Based ◽  
Post Discharge ◽  
Evidence Based Treatment ◽  
Beneficial Effects ◽  
Before And After ◽  
Secondary Outcomes

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.

Abstract 70: Participation in Cardiac Rehabilitation Is Associated with Reduced Rehospitalization Following Acute Myocardial Infarction

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Shannon M Dunlay ◽  
Victoria N Zysek ◽  
Quinn R Pack ◽  
Randal J Thomas ◽  
Jill M Killian ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Rehabilitation ◽  
Hospital Discharge ◽  
Univariate Analysis ◽  
Billing Data ◽  
Post Discharge ◽  
Repeated Events ◽  
Reduced Risk

Background: Participation in cardiac rehabilitation (CR) has been shown to decrease mortality following acute myocardial infarction (MI), but its impact on rehospitalizations requires examination. Methods: We included patients who were hospitalized with first-ever MI in Olmsted County Minnesota from 1987-2010 and survived to hospital discharge. Participation in CR within the first 30 days following MI was determined using billing data and was analyzed as a time-dependent covariate. The association between CR participation and all-cause rehospitalization was analyzed using Andersen-Gill models to account for repeated events. As CR participation is a non-randomized intervention, we adjusted for propensity to participate after fitting a logistic regression model using 13 factors significantly associated with participation on univariate analysis. Patients were censored at the time of death or last follow-up. Results: Among 2991 patients (mean age 67 years, 59% male, 31% ST elevation MI), 1480 (49%) participated in CR following acute MI hospital discharge (first session occurred at a mean of 9 days post-discharge). Most patients (75%) were rehospitalized at least once during a mean follow-up of 7.6 years, and CR participation was associated with reduced risk of rehospitalization. The rehospitalization rates were 39% and 59% at one year for participants and non-participants, respectively. In unadjusted analysis, CR participation was associated with a markedly decreased risk of rehospitalization (HR 0.51, 95% CI 0.49-0.53, p<0.001). After adjusting for propensity to participate, the association between CR participation and all-cause rehospitalization persisted (HR 0.70, 95% CI 0.67-0.73, p<0.001). Conclusions: CR participation is associated with a markedly reduced risk of rehospitalization after incident MI. In addition to reducing mortality, improving CR participation rates may have a large impact post-MI healthcare resource use.

Abstract P323: The Effect of Smoking Cessation on Weight at 12 Months in Patients Post-Myocardial Infarction

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Sonia M Grandi ◽  
Kristian B Filion ◽  
Andre Gervais ◽  
Lawrence Joseph ◽  
Jennifer O'Loughlin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Smoking Cessation ◽  
Weight Management ◽  
Weight Change ◽  
Controlled Trial ◽  
Self Report ◽  
Post Myocardial Infarction ◽  
Double Blind ◽  
The Mean

Background: Current guidelines recommend smoking cessation and weight management for secondary prevention in post-myocardial infarction (MI) patients. However, little is known about the effects of smoking cessation on weight change post-MI. Methods: We examined this question using data from a randomized, double-blind, placebo-controlled trial investigating the effect of bupropion on smoking cessation in patients immediately following a MI. Weight change was compared between 3 groups: patients who reported complete abstinence, those who reported intermittent smoking, and those who reported persistent smoking during the 12-month follow-up. Analyses were restricted to patients who attended all follow-up visits (N=179). Weight was collected by research nurses at follow-up. Abstinence was defined by self-report in the previous 7 days and a carbon monoxide level ≤10 ppm. Results: During follow-up, 92 patients were abstinent, 49 were intermittently smoking, and 38 were consistently smoking. At baseline, 68.7% of patients were male, and the mean age was 53.9 years (SD 10.0). The mean weight and BMI at baseline were 78.4 kg (SD 17.7) and 27.3 kg/m 2 (SD 5.0), respectively. Mean body weight increased in all 3 groups during follow-up ( Figure ). However, patients who remained abstinent were more likely to gain weight than those who smoked persistently (difference 3.3 kg, 95% CI 0.9, 5.6). No difference in weight change was present between persistent and intermittent smokers. Both intermittent and persistent smokers reduced their daily cigarette consumption between baseline and 12-month follow-up (mean difference −15.5, 95% CI −19.1, −11.9 and −15.8, 95% CI, −19.9, −11.7, respectively). Conclusions: Patients who remain abstinent are more likely to gain weight 12 months post-MI. Given the importance of weight management in this population, strategies to ensure long-term weight control among patients who quit smoking are needed.

Abstract 332: Persistent Use Of Evidence-Based Medications After Discharge Among Patients With Non-ST Elevation Myocardial Infarction Treated At Academic Versus Non-Academic Hospitals

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Jennifer Rymer ◽  
Lisa McCoy ◽  
Laine Thomas ◽  
Eric Peterson ◽  
Tracy Wang
Keyword(s):  
Myocardial Infarction ◽  
Beta Blockers ◽  
St Elevation Myocardial Infarction ◽  
Hospital Treatment ◽  
Evidence Based ◽  
Post Discharge ◽  
Academic Hospitals ◽  
St Elevation ◽  
And Gender

Background: While academic hospitals are more likely to apply evidence-based therapies in-hospital for patients with non-ST elevation myocardial infarction (NSTEMI) than non-academic hospitals, differences in post-discharge persistence of evidence-based medications have never been evaluated. Methods: We examined 3,184 NSTEMI patients over age 65 treated at 250 hospitals in 2006 in the CRUSADE registry linked to Medicare part D pharmacy data. Using multivariable Poisson regression adjusting for case mix, we compared continued filling of prescriptions for beta-blockers, ACEI/ARB, clopidogrel, and statins at 90 days and 1 year post-discharge between patients treated at academic and non-academic hospitals. Results: Patients treated at academic hospitals were more frequently non-white (19% vs. 8%, p<0.001), but age (median 76 years) and gender (53% female) were not significantly different from patients treated at non-academic hospitals. Patients at academic hospitals were more likely to have a Charlson score >4 (36% vs. 30%, p=0.001), yet the rates of in-hospital PCI (48%) and CABG (8%) were similar between groups. Rates of persistence to evidence-based medications did not differ substantially between patients treated at academic vs. non-academic hospitals at 90 days or 1 year (Table). Persistence to all drug classes prescribed at discharge was low and not significantly different between academic and non-academic hospitals at 90 days (46% vs. 45%, p=0.44 with adjusted incidence rate ratio (IRR)=0.99 (0.95,1.04) and at 1-year (39% vs. 39%, p=0.93, adjusted IRR=1.02 (0.98,1.07)). There were no significant differences in index hospitalization duration (median 4 days, interquartile range (IQR) 3-6 for both, p=0.51) and time to first post-discharge cardiac follow-up visit (median 28 days [IQR 15-54] vs. 28 days [IQR 16-56], p=0.25) between patients treated at academic vs. non-academic hospitals. Conclusion: Rates of persistence to evidence-based medications were similar between older NSTEMI patients treated at academic vs. non-academic hospitals, and may reflect similar in-hospital treatment and post-discharge cardiac follow-up. However, persistence rates are low both early and late post-discharge, highlighting a continued need for quality improvement efforts to optimize post-MI management.

Abstract 010: Characteristics of Patients and Hospitals Utilizing Advanced Providers for Post-myocardial Infarction Outpatient Care

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Jennifer Rymer ◽  
Anita Y Chen ◽  
Laine Thomas ◽  
Judith Stafford ◽  
Jonathan Enriquez ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Post Myocardial Infarction ◽  
Teaching Hospitals ◽  
Advanced Practice ◽  
Post Discharge ◽  
Nursing Facility ◽  
Physician Shortages ◽  
Risk Patients ◽  
Medicare Patients

Background: Physician shortages and reimbursement changes have led to greater utilization of advanced practice providers (APP). National patterns of APP utilization for post-myocardial infarction (MI) patients are unknown. Methods: We examined 29477 Medicare patients ≥65 years discharged alive after an MI at 364 US hospitals in the ACTION Registry-GWTG from 2007-2010. Using NPI data from Medicare claims, we determined whether a patient had an outpatient visit with an APP within 90 days after discharge. We compared characteristics of patients seen by an APP vs. a physician only, stratified by % hospital APP use. Results: Within 90 days of discharge, 11% of MI patients were seen by an APP. Patients seen by APPs were more likely to be female (49% vs. 45%), have diabetes (37% vs. 33%) or heart failure (20% vs. 16%), and discharged to a nursing facility (21% vs. 13%, p<0.01 for all) than patients seen by a physician only. The number of outpatient visits within 90 days of discharge was higher for APP patients (median 6 vs. 5, p<0.01). Among hospitals, the median % of patients discharged to APP follow-up was 9.1%. APP follow-up was used more by non-teaching than teaching hospitals (29% vs. 25%, p<0.01). Whether higher risk patients are referred to APP care did not differ much among hospitals that more or less frequently used an APP post-discharge (Figure). Conclusions: Current US practice reveals APPs are utilized to provide closer follow-up to more complex MI patients after discharge. APP referral patterns do not substantially vary by how frequently a hospital utilizes APPs.

scholarly journals Improving Smoking Cessation After Myocardial Infarction by Systematically Implementing Evidence-Based Treatment Methods: A Retrospective Observational Cohort Study

2021 ◽  
Author(s):  
Margret Leosdottir ◽  
Sanne Wärjerstam ◽  
Halldora Michelsen ◽  
Mona Schlyter ◽  
Emma Hag ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Smoking Cessation ◽  
High Risk Group ◽  
Routine Practice ◽  
Evidence Based ◽  
Post Discharge ◽  
Beneficial Effects ◽  
Before And After ◽  
Observational Cohort ◽  
Short Consultation

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.

scholarly journals Electronic cigarettes in standard smoking cessation treatment by tobacco counselors in Flanders: E-cigarette users show similar if not higher quit rates as those using commonly recommended smoking cessation aids

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Karolien Adriaens ◽  
Eline Belmans ◽  
Dinska Van Gucht ◽  
Frank Baeyens
Keyword(s):  
Smoking Cessation ◽  
Cohort Study ◽  
Replacement Therapy ◽  
Electronic Cigarettes ◽  
Evidence Based ◽  
Smoking Abstinence ◽  
Smoking Cessation Treatment ◽  
Cessation Treatment ◽  
Point Prevalence Abstinence

Abstract Background This interventional-cohort study tried to answer if people who smoke and choose an e-cigarette in the context of smoking cessation treatment by tobacco counselors in Flanders are achieving smoking abstinence and how they compare to clients who opt for commonly recommended (or no) aids (nicotine replacement therapy, smoking cessation medication). Methods Participants were recruited by tobacco counselors. They followed smoking cessation treatment (in group) for 2 months. At several times during treatment and 7 months after quit date, participants were asked to fill out questionnaires and to perform eCO measurements. Results One third of all participants (n = 244) achieved smoking abstinence 7 months after the quit date, with e-cigarette users having higher chances to be smoking abstinent at the final session compared to NRT users. Point prevalence abstinence rates across all follow-up measurements, however, as well as continuous and prolonged smoking abstinence, were similar in e-cigarette users and in clients having chosen a commonly recommended (or no) smoking cessation aid. No differences were obtained between smoking cessation aids with respect to product use and experiences. Conclusions People who smoke and choose e-cigarettes in the context of smoking cessation treatment by tobacco counselors show similar if not higher smoking cessation rates compared to those choosing other evidence-based (or no) smoking cessation aids.

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