Review of psychosocial quit-smoking interventions for patients with coronary heart disease

Feb 8 2008

Psychosocial interventions like counseling, telephone support and self-help materials can assist heart disease patients who are trying to give up cigarettes, but the most successful cessation treatments last a month or more, according to a new review of studies.

The review gathers evidence from 16 randomized controlled studies of psychosocial quit-smoking interventions for patients with coronary heart disease. Many of the study participants had experienced a heart attack or an invasive treatment such as bypass surgery or angioplasty.

“We found support for the efficacy of smoking cessation interventions with more than one-month duration, but brief interventions without some follow-up contact were not effective. We were unable to determine the minimum number of contacts needed,” the review authors write.

The review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Jürgen Barth, a senior researcher with the Institute of Social and Preventive Medicine at Bern University in Switzerland, led the review.

Coronary heart disease — the No. 1 cause of death in the United States — results from a buildup of plaque within the walls of the arteries that supply the heart muscle with oxygen and nutrients. Smokers have an increased risk for heart disease, and people with heart disease who smoke have an increased risk for heart attack and death.

Health professionals say that there is an added urgency to help people with heart disease give up the cigarette habit.

The review analyzed the effectiveness of different psychosocial quitting aids. The likelihood that a smoker with heart disease would remain abstinent after six to 12 months was similar for behavioral counseling, phone support and self-help (information booklets, audio- or videotapes) interventions.

“Most trials used a mixture of different intervention strategies, therefore no single strategy showed superior efficacy,” the review found.

Overall, psychosocial smoking cessation interventions in coronary heart disease patients required about 10 patients to undergo treatment for one person to be abstinent from tobacco after one year, the review found.

Saul Shiffman, addictive behavior researcher at the University of Pittsburgh, said many health care providers consider a heart attack a “teachable moment” that can persuade smokers to give up cigarettes.

“Many people do quit, but some don't,” Shiffman said. “The biggest lesson of the review is that you can't rely on a heart attack to scare everyone into quitting. It is just a moment and we need sustained interventions to translate that moment from the bedside into real life.”

The review authors say that after a cardiac event about 30 percent to 50 percent of smokers with coronary heart disease quit smoking without professional help. Psychosocial interventions are able to increase this rate, Barth said.

Heart disease is a slow-onset condition, so it is likely that many smokers with the condition have heard admonitions to quit smoking, Shiffman said.

He said that finding effective cessation treatments for people with heart disease is important because the patients who have not given up cigarettes are likely “battle-hardened smokers.”

The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions.

http://www.cochrane.org/