Smoking cessation in European patients with coronary heart disease. Results from the EUROASPIRE IV survey: A registry from the European Society of Cardiology
Section snippets
Background
Smoking is the most important modifiable risk factor for coronary heart disease (CHD) and a leading cause of death [1]. In patients with CHD, smoking cessation reduces the risk of recurrent events by 50% [2]. However, only half of smokers with CHD in Europe were able to successfully quit smoking [3,4].
The European guidelines on cardiovascular prevention in clinical practice recommend a comprehensive approach to risk factor management in secondary prevention of CHD [5].
Optimal secondary
Design and study population
The four EUROASPIRE surveys are cross-sectional studies which took place between 1999 and 2013 and have been described in detail elsewhere [3]. Briefly, the EUROASPIRE IV survey (2012–2013) was carried out in selected geographical areas in 24 European countries (78 hospitals). Consecutive patients (≥18 years and ≤80 years of age at the time of their recruiting event or procedure) were retrospectively identified with one of the following diagnoses: elective or emergency coronary artery bypass
Results
Information on smoking status was available in all interviewed patients (n = 7998). A total of 2458 (31%) patients were smoking in the month prior to the recruiting event or procedure. Of n = 2458 pre-event smokers, 1263 (51%) were successful quitters at the time of the interview (median 1.2 years [range 0.5 to 3 years]) (Appendix Fig. 1). Of 1195 (49%) persistent smokers, 593 reported at least one quit attempt in the last year (relapsers).
Smoking rates differed markedly among the participating
Discussion
Our study demonstrates substantial geographical variation in contemporary smoking cessation behaviour in patients with coronary artery disease in the large, cross-sectional EUROASPIRE IV survey. While the overall smoking cessation rate in the EUROASPIRE IV study was comparable to the cessation rates from earlier surveys (II–III), we observed large differences between participating countries. The proportion of patients who were successful quitters increased with increasing age and higher level
Strengths and limitations
There are several strengths to our study. First, our study population consisted of a large number of CHD patients from 24 European countries, in a contemporary clinical setting. Second, due to the repeated surveys and standardised data collection, we were able to compare cessation rates for successful quitting across several decades. Third, all data were based on interviews and objectively measured outcomes, such as expired carbon monoxide for smoking. Therefore, our analysis was based on high
Conclusions
Our study shows that smoking cessation rates in CHD patients throughout Europe have remained unchanged at around 50% since 1999 despite the availability of effective medications to support cessation. However, there is great variation between individual countries. Smoking cessation rates should therefore be interpreted in the light of pre-event smoking prevalences, and caution is advised when comparing individual European countries. Our findings may assist in developing strategies to assist
Acknowledgements
We thank the administrative staff, physicians, nurses and other personnel at the hospitals in which the study was carried out, and all the patients who participated in the study. The EUROASPIRE IV survey was carried out under the auspices of the European Society of Cardiology, EURObservational Research Programme. Unrestricted educational grants to the European Society of Cardiology were obtained from Amgen, AstraZeneca, Bristol-Myers Squibb/Emea Sarl, GlaxoSmithKline, F Hoffman-la Roch, Merck,
Funding
MS is supported by a research grant from the Netherlands Organisation for Scientific Research (NWO) (Grant number: 023.003.060). KK is supported by a research grant from the ESC to the IC London.
Conflict of interest
No conflict of interest exists with respect to this manuscript
References (25)
- et al.
Risk groups and predictors of short-term abstinence from smoking in patients with coronary heart disease
Heart Lung
(2012) - et al.
Increased leptin and decreased ghrelin level after smoking cessation
Neurosci. Lett.
(2006) - et al.
Effects of cigarette smoking and its cessation on body weight and plasma leptin levels
Metabolism
(1999) - et al.
Community based lifestyle intervention in patients with coronary artery disease. The RESPONSE-2 Trial
JACC
(2017) The Leading Causes of Death in the World, 2000 and 2012
(2014)- et al.
Smoking cessation for the secondary prevention of coronary heart disease
Cochrane Database Syst. Rev.
(2004) - et al.
EUROASPIRE IV: a European Society of Cardiology survey on the lifestyle, risk factor and therapeutic management of coronary patients from 24 European countries
Eur. J. Prev. Cardiol.
(2016) - et al.
EUROASPIRE III: a survey on the lifestyle, risk factors and use of cardioprotective drug therapies in coronary patients from 22 European countries
Eur J Cardiovasc Prev Rehabil
(2009) - et al.
2016 European Guidelines on cardiovascular disease prevention in clinical practice: the Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR)
Eur. Heart J.
(2016) - et al.
European guidelines on cardiovascular disease prevention in clinical practice (version 2012): the fifth joint task force of the European society of cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts)
Int. J. Behav. Med.
(2012)
European guidelines on cardiovascular disease prevention in clinical practice: full text. Fourth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts)
Eur J Cardiovasc Prev Rehabil
Smoking behaviour in European patients with established coronary heart disease
Eur. Heart J.
Cited by (24)
Organizational and patient-level predictors for attaining key risk factor targets in cardiac rehabilitation after myocardial infarction: The Perfect-CR study
2023, International Journal of CardiologyCitation Excerpt :Of the process-based metrics the strongest predictors included varenicline being prescribed by the centre physicians and recommending nicotine replacement therapy. Varenicline has been shown to increase the likelihood of achieving smoking abstinence, but the treatment is highly underutilized in CR [8,12,30]. Time spent with a nurse or physician during the first year post-MI was predictive for smoking abstinence, indicating that smokers perhaps should be designated more face-to-face time during follow-up.
Fagerstrom score predicts smoking status six months after hospitalization for acute myocardial infarction: a prospective study
2022, Hellenic Journal of CardiologyCitation Excerpt :On the other hand, smoking cessation is one of the most beneficial interventions both for primary and secondary cardiovascular prevention.3 However, according to the multi-center study, EUROASPIRE IV survey, 40–60% of AMI survivors in Europe do not stop smoking after AMI.4 Intervention provided at the right time can increase the possibility of a sustained smoking cessation in the long-term.
Smoking cessation: A challenge for cardiologists and pulmonologists
2019, Revue des Maladies RespiratoiresThe importance of smoking cessation in patients with coronary heart disease
2018, International Journal of CardiologySmoking cessation after coronary angiography and percutaneous coronary intervention
2022, Polish Archives of Internal Medicine