Health outcomes/public policy
Promoting smoking cessation during hospitalization for coronary artery diseaseLa promotion de l’abandon du tabac pendant une hospitalisation secondaire à une coronaropathie

https://doi.org/10.1016/S0828-282X(06)70294-XGet rights and content

Background

Quitting smoking is the most effective intervention to reduce mortality in patients with coronary artery disease who smoke. Guidelines for the treatment of tobacco dependency recommend that health care institutions develop plans to support the consistent and effective identification and treatment of tobacco users. The University of Ottawa Heart Institute (Ottawa, Ontario) has implemented an institutional program to identify and treat all smokers admitted to the Institute.

Objectives

The objectives of the present paper are to describe core elements of this program and present data concerning its reach and effectiveness.

Program description

The goal of the program is to increase the number of smokers who are abstinent from smoking six months after a coronary artery disease-related hospitalization. Core elements of the program include: documentation of smoking status at hospital admission; inclusion of cessation intervention on patient care maps; individualized, bedside counselling by a nurse counsellor; the appropriate and timely use of nicotine replacement therapy; automated telephone follow-up; referral to outpatient cessation resources; and training of medical residents and nursing staff. Program reach and effectiveness were measured over a one-year period.

Results

Between April 2003 and March 2004, almost 1300 smokers were identified at admission, and 91% received intervention to help them quit smoking. At six-month follow-up, 44% were smoke-free.

Conclusions

Hospitalization for coronary artery disease provides an important opportunity to intervene with smokers when their motivation to quit is high. An institutional approach reinforces the importance of smoking cessation in this patient population and increases the rate of smoking cessation. Posthospitalization quit rates should be a benchmark of cardiac program performance.

Historique

L’abandon du tabac est l’intervention la plus efficace pour réduire la mortalité chez les patients fumeurs atteints d’une coronaropathie. D’après les lignes directrices pour le traitement de la dépendance au tabac, les établissements de santé doivent élaborer des plans pour soutenir le dépistage et le traitement efficace et cohérent des fumeurs. L’Institut de cardiologie de l’Université d’Ottawa a implanté un programme pour repérer et traiter tous les fumeurs hospitalisés à l’Institut.

Objectifs

Le présent article vise à décrire les principaux éléments de ce programme et à présenter des données reliées à sa portée et à son efficacité.

Description du programme

Le programme vise à accroître le nombre de fumeurs qui s’abstiennent toujours de fumer six mois après une hospitalisation secondaire à une coronaropathie. Les principaux éléments du programme sont la documentation de l’état de fumeur au moment de l’hospitalisation, l’inclusion d’interventions d’abandon du tabac dans le plan de soins standard des patients, des conseils personnalisés au chevet du patient par une infirmière-conseil, le recours rapide et pertinent à une thérapie de remplacement de la nicotine, le suivi téléphonique automatisé, l’aiguillage vers des ressources externes d’abandon du tabac et la formation des résidents en médecine et du personnel infirmier. La portée et l’efficacité du programme ont été mesurées sur une période d’un an.

Résultats

Entre avril 2003 et mars 2004, plus de 1 300 fumeurs ont été dépistés à l’hospitalisation, et 91 % ont reçu une intervention pour les aider à cesser de fumer. Au suivi de six mois, 44 % ne fumaient toujours pas.

Conclusions

L’hospitalisation secondaire à une coronaropathie constitue une excellente occasion pour intervenir auprès des fumeurs lorsque leur motivation à cesser de fumer est élevée. Une démarche en établissement renforce l’importance de l’abandon du tabac au sein de cette population de patients et accroît le taux d’abandon du tabac. Le taux d’abandon après l’hospitalisation devrait constituer un point de référence du rendement des programmes cardiaques.

References (16)

  • J. Ludvig et al.

    Smoking cessation in patients with coronary artery disease

    Am Heart J

    (2005)
  • E.K. France et al.

    Smoking cessation interventions among hospitalized patients: What have we learned?

    Prev Med

    (2001)
  • J.A. Critchley et al.

    Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: A systematic review

    JAMA

    (2003)
  • The Growing Burden of Heart Disease and Stroke in Canada

    (2003)
  • R. Reid et al.

    Stepped care approach to smoking cessation in patients hospitalized for coronary artery disease

    J Cardiopulm Rehabil

    (2003)
  • M.C. Fiore et al.

    Effective tobacco dependence treatment

    JAMA

    (2002)
  • A. Pipe

    Smoking

    Can J Cardiol

    (1999)
  • T.F. van Berkel et al.

    Impact of smoking cessation and smoking interventions in patients with coronary heart disease

    Eur Heart J

    (1999)
There are more references available in the full text version of this article.

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