BMJ 2002;324:87-89 ( 12 January )

Papers

Brief intervention during hospital admission to help patients to give up smoking after myocardial infarction and bypass surgery: randomised controlled trial

Peter Hajek, professor of clinical psychology, ^a Tamara Z Taylor, research psychologist, ^a Peter Mills, consultant cardiologist. ^b

^a Department of Human Science and Medical Ethics, Bart's and The London, Queen Mary's School of Medicine and Dentistry, London E1 2AD, ^b London Chest Hospital, London E2 9JA

Correspondence to: P Hajek p.hajek{at}qmul.ac.uk

Objective: To evaluate a smoking cessation intervention that can be routinely delivered to smokers admitted with cardiac problems.
Design: Randomised controlled trial of usual care compared with intervention delivered on hospital wards by cardiac rehabilitation nurses.
Setting: Inpatient wards in 17 hospitals in England.
Participants: 540 smokers admitted to hospital after myocardial infarction or for cardiac bypass surgery who expressed interest in stopping smoking.
Intervention: Brief verbal advice and standard booklet (usual care). Intervention lasting 20-30 minutes including carbon monoxide reading, special booklet, quiz, contact with other people giving up, declaration of commitment to give up, sticker in patient's notes (intervention group).
Main outcome measures: Continuous abstinence at six weeks and 12 months determined by self report and by biochemical validation at these end points. Feasibility of the intervention and delivery of its components.
Results: After six weeks 151 (59%) and 159 (60%) patients remained abstinent in the control and intervention group, respectively (P=0.84). After 12 months the figures were 102 (41%) and 94 (37%) (P=0.40). Recruitment was slow, and delivery of the intervention was inconsistent, raising concerns about the feasibility of the intervention within routine care. Patients who received the declaration of commitment component were almost twice as likely to remain abstinent than those who did not receive it (P<0.01). Low dependence on tobacco and high motivation to give up were the main independent predictors of positive outcome. Patients who had had bypass surgery were over twice as likely to return to smoking as patients who had had a myocardial infarction.
Conclusions: Single session interventions delivered within routine care may have insufficient power to influence highly dependent smokers.

What is already known on this topic Stopping smoking after a serious cardiac event is associated with a significant decrease in mortality Up to 70% of smokers who survive cardiac surgery smoke again within a year Intensive interventions delivered by dedicated staff can help cardiac patients not to start to smoke again What this study adds An intervention delivered by cardiac rehabilitation nurses within routine care during patients' hospital stay failed to increase the number who managed to stop smoking in the long term For busy staff with competing priorities, the 30 minute intervention was also on the borderline of practicability Patients admitted after a myocardial infarction were over twice as likely to give up than those admitted for a bypass operation

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