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Smoking Cessation after Acute Myocardial Infarction: Effects of a Nurse-Managed Intervention

C. Barr Taylor, MD; Nancy Houston-Miller, RN; Joel D. Killen, PhD; and Robert F. DeBusk, MD
[+] Article, Author, and Disclosure Information

Grant Support: In part by grant HL30529 from the National Heart, Lung and Blood Institute.

Requests for Reprints: C. Barr Taylor, MD, Department of Psychiatry, TD215, Stanford University School of Medicine, Stanford, CA 94305-5490.

Current Author Addresses: Dr. Taylor: Department of Psychiatry, TD215, Stanford University School of Medicine, Stanford, CA 94305-5490.

Ms. Houston-Miller and Dr. DeBusk: 780 Welch Road, #106, Palo Alto, CA 94304.

Dr. Killen: Center for Research in Disease Prevention, 1000 Welch Road, Palo Alto, CA 94304.

© 1990 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1990;113(2):118-123. doi:10.7326/0003-4819-113-2-118
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Study Objective: To determine the effect of a nurse-managed intervention for smoking cessation in patients who have had a myocardial infarction.

Design: Randomized, with a 6-month treatment period and a 6-month follow-up.

Setting: Kaiser Foundation hospitals in Redwood City, Santa Clara, Hayward, and San Jose, California.

Patients: Sequential sample of 173 patients, 70 years of age or younger, who were smoking before hospitalization for acute myocardial infarction. Eighty-six patients were randomly assigned to the intervention and 87 to usual care; 130 patients (75%) completed the study and were available for follow-up.

Intervention: Nurse-managed and focused on preventing relapse to smoking, the intervention was initiated in the hospital and maintained thereafter primarily through telephone contact. Patients were given an 18-page manual that emphasized how to identify and cope with high-risk situations for smoking relapse.

Measurements and Main Results: One year after myocardial infarction, the smoking cessation rate, verified biochemically, was 71% in the intervention group compared with 45% in the usual care group, a 26% difference (95% CI, 9.5% to 42.6%). Assuming that all surviving patients lost to follow-up were smoking, the 12-month smoking cessation rate was 61% in the intervention group compared with 32% in the usual care group, a 29% difference (95% CI, 14.5% to 43.5%). Patients who either resumed smoking within 3 weeks after infarction or expressed little intention of stopping in the hospital were unlikely to have stopped by 12 months.

Conclusions: A nurse-managed smoking cessation intervention largely conducted by telephone, initiated in the hospital, and focused on relapse prevention can significantly reduce smoking rates at 12 months in patients who have had a myocardial infarction.





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