Return to smoking after heart attack ups death risk

On average, people who started smoking again after being hospitalized for acute coronary syndrome ACS — crushing chest pain that often signals a heart attack — were more than three times as likely to die within a year as people who successfully quit in a study led by Dr Furio Colivicchi of San Filippo Neri Hospital in Rome

“Relapse is a major risk factor for long term survival,” said Dr David Katz, associate professor of internal medicine at University of Iowa Carver College of Medicine in Iowa City

Quitting smoking has a similar lifesaving effect for ACS patients as taking recommended drugs to lower blood pressure or cholesterol, added Katz, who was not involved in the new study

To gauge the effects of resuming smoking after a heart “event,” and to see how many people are likely to relapse, Colivicchi and his colleagues tracked 1294 patients who reported being regular smokers before they were hospitalized with ACS

All the participants had ceased smoking while in the hospital and declared themselves motivated to continue abstaining once they were released Patients received a few brief smoking-cessation counseling sessions while in the hospital, but no further counseling, nicotine replacement or other smoking-cessation help was provided after they left the hospital

The researchers interviewed patients about their smoking status at one, six, and 12 months after their release from the hospital and found that a total of 813 63 percent had relapsed by the end of the first year About half had begun smoking again within 20 days of leaving the hospital

Within a year, 97 patients died, with 81 of those deaths attributed to cardiovascular causes, according to findings published in the American Journal of Cardiology

After adjusting for patient ages and other variables, the researchers found that resuming smoking raised a person’s risk of death three-fold compared to patients who didn’t relapse

The earlier a patient fell off the wagon, the more likely he or she was to die within a year — those who resumed smoking within 10 days of leaving the hospital were five times as likely to die as those who continued to abstain

Very few patients relapsed after being smoke-free for six months

“If you manage to stay off cigarettes for six months, you probably have the addiction beat,” said Dr Nancy Rigotti, director of the Tobacco Research and Treatment Unit at Massachusetts General Hospital in Boston, who was not involved in the study

Colivicchi’s group did not measure how often the patients smoked — an important predictor of relapse and early death, Katz noted

Nonetheless, the results indicate a need to improve the way doctors help patients quit smoking, said Rigotti

“People don’t take treating tobacco use seriously in the medical setting,” and recommended treatments have not made their way into practice, she said

Colivicchi agreed A successful program to help patients quit should take “a comprehensive long-term approach, including individual counseling, post-discharge support and pharmacological treatment,” he told Reuters Health in an email

A recent study from Harvard Medical School suggested that a comprehensive anti-smoking counseling program for heart attack patients could save thousands of lives at a relatively low cost

These findings, along with the results of the Italian study, said Rigotti, suggest that hospitals and insurers should work together to implement comprehensive anti-smoking programs to continue to help patients after they leave the hospital

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This entry was posted on Thursday, July 21st, 2011 at 7:05 pm and is filed under Health Ideas. You can leave a response, or trackback from your own site.

 

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