Smoking cessation in European patients with coronary heart disease. Results from the EUROASPIRE IV survey: A registry from the European Society of Cardiology

doi:10.1016/j.ijcard.2018.01.064

International Journal of Cardiology

Volume 258, 1 May 2018, Pages 1-6

https://doi.org/10.1016/j.ijcard.2018.01.064 Get rights and content

Highlights

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Across EUROASPIRE II–IV survey cohorts, the smoking cessation percentage remained unchanged.
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Smoking cessation rates should be interpreted in the light of pre-event smoking prevalence.
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Successful quitters reported more actions to make healthy lifestyle changes as compared with persistent smokers.
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Successful quitters more frequently reported to attend a cardiac rehabilitation programme compared with persistent smokers.
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Attendance at a smoking cessation programme was less prevalent in successful quitters as compared with persistent smokers.

Abstract

Objective

We investigated smoking cessation rates in coronary heart disease (CHD) patients throughout Europe; current and as compared to earlier EUROASPIRE surveys, and we studied characteristics of successful quitters.

Methods

Analyses were done on 7998 patients from the EUROASPIRE-IV survey admitted for myocardial infarction, unstable angina and coronary revascularisation. Self-reported smoking status was validated by measuring carbon monoxide in exhaled air.

Results

Thirty-one percent of the patients reported being a smoker in the month preceding hospital admission for the recruiting event, varying from 15% in centres from Finland to 57% from centres in Cyprus. Smoking rates at the interview were also highly variable, ranging from 7% to 28%.

The proportion of successful quitters was relatively low in centres with a low number of pre- event smokers.

Overall, successful smoking cessation was associated with increasing age (OR 1.50; 95% CI 1.09–2.06) and higher levels of education (OR 1.38; 95% CI 1.08–1.75).

Successful quitters more frequently reported that they had been advised (56% vs. 47%, p < .001) and to attend (81% vs. 75%, p < .01) a cardiac rehabilitation programme.

Conclusion

Our study shows wide variation in cessation rates in a large contemporary European survey of CHD patients. Therefore, smoking cessation rates in patients with a CHD event should be interpreted in the light of pre-event smoking prevalence, and caution is needed when comparing cessation rates across Europe.

Furthermore, we found that successful quitters reported more actions to make healthy lifestyle changes, including participating in a cardiac rehabilitation programme, as compared with persistent smokers.

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

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Benefits of cardiac rehabilitation (CR) programme components on attaining risk factor targets post-myocardial infarction (MI) and their predictive strength relative to patient characteristics remain unclear. We aimed to identify organizational and patient-level predictors of risk factor target attainment at one-year post-MI.
In this observational study data on CR organization at 78 Swedish CR centres was collected and merged with patient-level registry data (n = 7549). Orthogonal partial least squares discriminant analysis identified predictors (Variables of Importance for the Projection (VIP) values >0.8) of attaining low-density lipoprotein-cholesterol (LDL-C) <1.8 mmol/L, blood pressure (BP) <140/90 mmHg and smoking abstinence.
The strongest predictors (VIP [95% CI]) for attaining LDL-C and BP targets were offering psychosocial management (2.14 [1.78–2.50]; 2.45 [1.91–2.99]), having a psychologist in the CR team (1.62 [1.36–1.87]; 2.05 [1.67–2.44]), extended opening hours (2.13 [2.00–2.27]; 1.50 [0.91–2.10]), adequate facilities (1.54 [0.91–2.18]; 1.89 [1.38–2.40]), and having a medical director (1.70 [0.91–2.48]; 1.46 [1.04–1.88]). The strongest patient-level predictors of attaining LDL-C and/or BP targets were low baseline LDL-C (3.95 [3.39–4.51]) and having no history of hypertension (2.93 [2.60–3.26]), respectively, followed by exercise-based CR participation (1.38 [0.66–2.10]; 1.46 [1.14–1.78]). For smoking abstinence, the strongest organizational predictor was varenicline being prescribed by CR physicians (1.88 [0.95–2.80]) and patient-level predictors were participation in exercise-based CR (2.47 [2.07–2.88]) and group education (1.92 [1.43–2-42]), and no cardiovascular disease history (2.13 [1.78–2.48]).
We identified multiple CR organizational and patient-level predictors of attaining risk factor targets post-MI. These results may influence the future design of comprehensive CR programmes.
Fagerstrom score predicts smoking status six months after hospitalization for acute myocardial infarction: a prospective study
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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.
Fagerstrom score is a validated marker of nicotine addiction in smokers.
In a prospective study, we investigated a) the predictive value of Fagerstrom score for the smoking status in patients early after acute myocardial infarction (AMI) and b) the effectiveness of medically assisted smoking cessation programs in the prevention of relapsing to smoking post discharge. In 103 smokers (58 ± 12 years, 79.6% males), we assessed Fagerstrom score during hospitalization for AMI. Patients filled a dedicated questionnaire including data on family, marital and educational status, habits related to smoking and were followed-up at 3 and 6 months after discharge.
Twenty-eight patients (27.2%) did not quit smoking throughout the 6-months follow-up period (Fagerstrom score:8.1 ± 1.6), 39 patients (37.8%) ceased smoking at 3 months but relapsed to smoking at 6 months (score:6.8 ± 2.1), and only 34 patients (33%) had ceased smoking for 6 consecutive months (score:5.2 ± 2 p < 0.05 for all comparisons between subgroups). By multivariate analysis, Fagerstrom score remained a significant predictor of smoking cessation at 6 months (OR: 0.72, 95%CI: 0.60--0.86, p < 0.001). Out of 73 patients who abstained from smoking for the first 3 months post-AMI, those who participated in a smoking cessation program displayed lower rate of relapsing to smoking compared with those who opted to cease smoking without any support (33.3% vs 61.8% p = 0.012).
Fagerstrom score is a useful predictor of smoking cessation 6 months post-AMI. Patients participating in a smoking cessation program display lower relapse rates post-discharge suggesting the need of well-organized smoking cessation clinics for secondary prevention of heart disease.
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À côté de mesures de santé publique fortement soutenues politiquement, le tabagisme est également un enjeu médical majeur. Véritable maladie chronique, compte tenu de son caractère extrêmement addictif, il doit être pris en charge activement par tous les acteurs de santé. Le tabagisme étant responsable de la majorité des pathologies concernant leurs spécialités, cardiologues et pneumologues sont en première ligne dans cette prise en charge. Sont analysés, dans cette revue, l’état actuel de cette prise en charge et ses insuffisances, l’impact limitant du propre tabagisme des médecins ainsi que les idées fausses véhiculées par les fumeurs et parfois les médecins eux-mêmes, qui sont autant de freins pour un sevrage. Le sevrage tabagique doit en pratique devenir un véritable traitement que tout médecin doit savoir parfaitement gérer : ne pas se contenter du simple conseil d’arrêt, apprendre à aborder efficacement un fumeur, connaître le maniement des différentes aides médicamenteuses souvent indispensables et savoir organiser le suivi du sevrage, gage essentiel de la réussite. Si la gestion optimale de ce facteur pathologique majeur est l’affaire de tous les médecins, c’est bien sûr également celle de nos deux spécialités. À nous, cardiologues et pneumologues, de relever ce défi.
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View full text

Smoking cessation in European patients with coronary heart disease. Results from the EUROASPIRE IV survey: A registry from the European Society of Cardiology

Highlights

Abstract

Objective

Methods

Results

Conclusion

Section snippets

Background

Design and study population

Results

Discussion

Strengths and limitations

Conclusions

Acknowledgements

Funding

Conflict of interest

Heart Lung

Neurosci. Lett.

Metabolism

JACC

The Leading Causes of Death in the World, 2000 and 2012

Smoking cessation for the secondary prevention of coronary heart disease

Cochrane Database Syst. Rev.

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.

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

Eur. Heart J.

Int. J. Behav. Med.

Eur J Cardiovasc Prev Rehabil

Smoking behaviour in European patients with established coronary heart disease

Eur. Heart J.