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Pleym K, Dammen T, Wedon-Fekjaer H, Husebye E, Sverre E, Tonstad S, Munkhaugen J. A multi-component intervention increased access to smoking cessation treatment after hospitalization for atherosclerotic cardiovascular disease: a randomized trial. EUROPEAN HEART JOURNAL OPEN 2024; 4:oeae028. [PMID: 38666249 PMCID: PMC11044967 DOI: 10.1093/ehjopen/oeae028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/25/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024]
Abstract
Aims To evaluate the effects of a multi-component intervention for smokers hospitalized for atherosclerotic cardiovascular disease (ASCVD) on the participation rate in community-based cessation programmes and the use of cessation drugs. Additionally, to explore the impact on the cessation rates at 6 months. Methods and results A randomized parallel-group study was conducted at a Norwegian secondary care hospital in 2021. The intervention group was: (i) counselled using motivational interviewing techniques during hospitalization; (ii) given an information leaflet, detailing the cessation programme; and (iii) referred to the community-based smoking cessation treatment including a post-discharge pro-active telephone invitation. The control group received usual care and the same information leaflet containing clear contact details for initiating participation. Data were collected at baseline, 1, 3, and 6 months. Among 99 smokers hospitalized with ASCVD, 40 were excluded. Of 59 randomized patients, 4 were lost to follow-up and 55 completed the study. The mean age was 65.1 (standard deviation 9.3) years, 35% were female, and 88% had smoked >20 years. Co-morbidity was prevalent (mean Charlson score 4.8). The intervention group was more likely to participate in the smoking cessation treatment {48 vs. 7%, difference: 41% [95% confidence interval (CI): 14%, 63%]} and used cessation drugs more frequently [59 vs. 21%, difference: 38% (95% CI: 17%, 59%)]. At the 6 months point prevalence, we observed notable between-group differences in self-reported cessation rate (48 vs. 25%). Conclusion The intervention significantly increased the participation rate at community-based smoking cessation programmes and the use of cessation drugs among multi-morbid smokers hospitalized for ASCVD.
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Affiliation(s)
- Karin Pleym
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Dronninggata 48, 3004 Drammen, Norway
- Department of Behavioural Medicine, Faculty of Medicine, University of Oslo, Sognsvannsveien 9, 0372 Oslo, Norway
| | - Toril Dammen
- Division of Mental Health and Addiction, Department of Research and Innovation, Oslo University Hospital, Sognsvannsveien 2, 0372 Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Klaus Torgårds vei 3, 0372 Oslo, Norway
| | - Harald Wedon-Fekjaer
- Oslo Center for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Sognsvannsveien 9, 0372 Oslo, Norway
| | - Einar Husebye
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Dronninggata 48, 3004 Drammen, Norway
| | - Elise Sverre
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Dronninggata 48, 3004 Drammen, Norway
| | - Serena Tonstad
- Department of Endocrinology, Obesity and Preventive Medicine, Section of Preventive Cardiology, Oslo University Hospital, Trondheimsveien 235, 0586 Oslo, Norway
| | - John Munkhaugen
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Dronninggata 48, 3004 Drammen, Norway
- Department of Behavioural Medicine, Faculty of Medicine, University of Oslo, Sognsvannsveien 9, 0372 Oslo, Norway
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2
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Lo CH, Li LC, Chang KW, Tsai CF, Su CH, Lo TH, Yen CH, Chan KC. Safety and efficacy of early varenicline prescription in hospitalized patients with acute myocardial infarction: East Asian population. J Formos Med Assoc 2023; 122:1035-1041. [PMID: 37002175 DOI: 10.1016/j.jfma.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/26/2022] [Accepted: 03/15/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Smoking is a strong risk factor for patients with acute myocardial infarction (AMI). Varenicline is commonly used as a smoking cessation medication, but little is known about its usage in patients with AMI, particularly in hospitalized patients. METHODS This is a prospective observational, single-center study collected from May 2018 to July 2021. Study patients underwent percutaneous coronary intervention for AMI. The primary end point was set as safety of varenicline, focusing on any serious adverse cardiac events within 24 weeks after treatment. Efficacy of smoking abstinence was also assessed through self-reports of complete abstinence over a week before the 24- week clinic visit. RESULTS A total of 162 patients hospitalized with AMI were enrolled in our study. Mean age was 56.7 ± 9.95 years and 97% of the patients were male. Most patients (93.2%) received their first dose of varenicline during hospitalization. Time from admission to first dose of study medication was 2.31 ± 2.73 days and duration of drug intake was 7.41 ± 5.18 weeks. At week 24, only one patient had recurrent myocardial infarction, five patients had undergone revascularization for target lesion failure, and no additional patients developed stroke or died. In terms of efficacy, the rate of smoking abstinence was 79%. Light smokers found it easier to quit smoking than heavy smokers. CONCLUSION This study may represent the first report on the safety and efficacy of early initiation of varenicline treatment in East Asian population hospitalized due to AMI who recently underwent percutaneous coronary intervention.
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Affiliation(s)
- Chien-Hsien Lo
- Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Division of Cardiology, Department of Internal Medicine, Chung-Shan Medical University Hospital, Taichung, Taiwan
| | - Li-Ching Li
- Department of Internal Medicine, Da-Chien General Hospital, Miaoli, Taiwan
| | - Kai-Wei Chang
- Division of Cardiology, Department of Internal Medicine, Chung-Shan Medical University Hospital, Taichung, Taiwan
| | - Chin-Feng Tsai
- Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Division of Cardiology, Department of Internal Medicine, Chung-Shan Medical University Hospital, Taichung, Taiwan
| | - Chun-Hung Su
- Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Division of Cardiology, Department of Internal Medicine, Chung-Shan Medical University Hospital, Taichung, Taiwan
| | - Tse-Hsien Lo
- Department of Internal Medicine, Chung-Shan Medical University Hospital, Taichung, Taiwan
| | - Chi-Hua Yen
- Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Family and Community Medicine, Chung-Shan Medical University Hospital, Taichung, Taiwan.
| | - Kuei-Chuan Chan
- Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Division of Cardiology, Department of Internal Medicine, Chung-Shan Medical University Hospital, Taichung, Taiwan.
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Gaalema DE, Khadanga S, Pack QR. Clinical challenges facing patient participation in cardiac rehabilitation: cigarette smoking. Expert Rev Cardiovasc Ther 2023; 21:733-745. [PMID: 37938825 DOI: 10.1080/14779072.2023.2282026] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/07/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION Cardiac rehabilitation (CR) is highly effective at reducing morbidity and mortality. However, CR is underutilized, and adherence remains challenging. In no group is CR attendance more challenging than among patients who smoke. Despite being more likely to be referred to CR, they are less likely to enroll, and much more likely to drop out. CR programs generally do not optimally engage and treat those who smoke, but this population is critical to engage given the high-risk nature of continued smoking in those with cardiovascular disease. AREAS COVERED This review covers four areas relating to CR in those who smoke. First, we review the evidence of the association between smoking and lack of participation in CR. Second, we examine how smoking has historically been identified in this population and propose objective screening measures for all patients. Third, we discuss the optimal treatment of smoking within CR. Fourth, we review select populations within those who smoke (those with lower-socioeconomic status, females) that require additional research and attention. EXPERT OPINION Smoking poses a challenge on multiple fronts, being a significant predictor of future morbidity and mortality, as well as being strongly associated with not completing the secondary prevention program (CR) that could benefit those who smoke the most.
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Affiliation(s)
- Diann E Gaalema
- Department of Psychiatry, University of Vermont, Burlington, VT, United States of America
| | - Sherrie Khadanga
- Cardiac Rehabilitation and Prevention, University of Vermont Medical Center, South Burlington, VT, United States of America
| | - Quinn R Pack
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts Chan Medical School - Baystate, Springfield, MA, United States of America
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Albury C, Barnes R, Ferrey A, Coleman T, Gilbert H, Naughton F, Aveyard P, Begh R. The old and familiar meets the new and unknown: patient and clinician perceptions on e-cigarettes for smoking reduction in UK general practice, a qualitative interview study. Addiction 2022; 117:1427-1437. [PMID: 34859526 PMCID: PMC9306504 DOI: 10.1111/add.15760] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 11/05/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Clinicians could promote e-cigarettes for harm reduction to people who smoke but cannot stop, but many clinicians feel uneasy doing so. In a randomized controlled trial (RCT), primary care clinicians offered free e-cigarettes and encouraged people with chronic diseases who were unwilling to stop smoking to switch to vaping. We interviewed clinicians and patients to understand how to adopt harm reduction in routine practice. DESIGN Qualitative analysis nested within an RCT, comprising thematic analysis of semi-structured interviews with primary care clinicians who delivered the trial intervention, and patients who took part. SETTING Primary care clinics in England. PARTICIPANTS/CASES Twenty-one patients and 11 clinicians, purposively sampled from an RCT. MEASUREMENTS We qualitatively explored patients' and clinicians' experiences of: being offered/offering an e-cigarette, past and current perceptions about e-cigarettes and applying a harm reduction approach. FINDINGS Four themes captured clinicians' and patients' reported perspectives. These were: (1) concepts of safety/risk, with clinicians concerned about recommending a product with unknown long-term risks and patients preferring the known risks of cigarettes; (2) clinicians felt they were going out on a limb by offering these as though they were prescribing them, whereas patients did not share this view; (3) equating quitting with success, as both patients and clinicians conceptualized e-cigarettes as quitting aids; and (4) unchanged views, as clinicians reported that training did not change their existing views about e-cigarettes. These themes were united by the higher-order concept: 'The old and familiar meets the new and unknown', as a contradiction between this new approach and long-established methods underpinned these concerns. CONCLUSIONS A qualitative analysis found barriers obstructing clinicians and patients from easily accepting e-cigarettes for harm reduction, rather than as aids to support smoking cessation: clinicians had difficulty reconciling harm reduction with their existing ethical models of practice, even following targeted training, and patients saw e-cigarettes as quitting aids.
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Affiliation(s)
- Charlotte Albury
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - Rebecca Barnes
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - Anne Ferrey
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - Tim Coleman
- Division of Primary CareUniversity of NottinghamNottinghamUK
| | - Hazel Gilbert
- Dept. of Primary Care and Population HealthUniversity College LondonLondonUK
| | - Felix Naughton
- School of Health SciencesUniversity of East AngliaNorwichUK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - Rachna Begh
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
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Kaldal A, Tonstad S, Jortveit J. Long-term hospital-based secondary prevention of coronary artery disease: a randomized controlled trial. BMC Cardiovasc Disord 2021; 21:600. [PMID: 34915839 PMCID: PMC8679993 DOI: 10.1186/s12872-021-02426-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND AIMS Despite established guidelines on secondary prevention of cardiovascular disease, practical implementation of treatment targets is deficient even in high-income countries. This study compared long-term hospital-based treatment with follow-up at primary health care regarding new cardiovascular events and achievement of treatment targets. METHODS This randomized controlled trial at Sørlandet Hospital, Norway 2007-2021 included patients hospitalized due to myocardial infarction (n = 760) or after scheduled percutaneous coronary intervention (PCI) (n = 677) or coronary artery bypass grafting (n = 103). Patients were randomized to hospital-based secondary preventive care with consultations 2 weeks, 3 months, 6 months and 1 year after the index event and annually for up to 5 years, or follow-up at primary health care. Final data was collected after 10 years and hazard ratios were calculated using Cox regression analyses. RESULTS Composite endpoint-free survival due to a lower rate of PCI improved in patients with hospital-based follow-up (n = 788) compared to patients followed-up at primary health care (n = 752) (HR 0.80, 95% CI 0.66-0.96; p = 0.02) but all-cause mortality was not reduced (HR 0.96, 95% CI 0.59-1.56; p = 0.86). At 1 year, LDL-cholesterol (2.1 [SD 0.7] versus 2.3 [SD 0.8] mmol/l; p < 0.001) and systolic blood pressure (132 [SD 16] versus 142 [SD 20] mm/Hg; p < 0.001) were lower in the hospital-based group, and the differences remained significant during the first 5 years. Other secondary preventive measures (smoking cessation, physical activity, body weight, glucose control, drug adherence) did not differ. CONCLUSIONS Long-term hospital-based secondary preventive follow-up improved composite endpoint-free survival, but not mortality. Substantial risk factors remained unaddressed. The beneficial effects on blood pressure and LDL-cholesterol disappeared after annual consultations ceased. TRIAL REGISTRATION The study is registered in ClinicalTrials.gov (NCT00679237) May 16, 2008.
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Affiliation(s)
- Anete Kaldal
- Department of Research, Sørlandet Hospital HF, Lundsiden, Box 416, 4604, Kristiansand S, Norway.
| | - Serena Tonstad
- Department of Endocrinology, Obesity and Preventive Medicine, Section of Preventive Cardiology, Oslo University Hospital, Oslo, Norway
| | - Jarle Jortveit
- Department of Cardiology, Sørlandet Hospital Arendal, Arendal, Norway
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Lovatt S, Wong CW, Holroyd E, Butler R, Phan T, Patwala A, Loke YK, Mallen CD, Kwok CS. Smoking cessation after acute coronary syndrome: A systematic review and meta-analysis. Int J Clin Pract 2021; 75:e14894. [PMID: 34541754 DOI: 10.1111/ijcp.14894] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/02/2021] [Accepted: 09/17/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Smoking cessation is an effective secondary prevention measure after acute coronary syndrome (ACS). We conducted a systematic review with the aim to better understand which patients have a greater propensity to quit smoking and the risk factors for continued smoking after ACS. METHODS We searched MEDLINE and EMBASE for studies that evaluated smoking cessation after ACS. The pooled rate of smoking cessation across included studies was performed. Random effects meta-analysis for different variables and their association with smoking cessation was conducted. RESULTS A total of 39 studies with 11 228 patients were included in this review. The pooled rate of smoking cessation following ACS across 38 studies was 45.0%. Factors associated with greater likelihood of smoking cessation were attendance at cardiac rehabilitation (OR 1.90 95% CI 1.44-2.51), married/not alone (OR 1.68 95% CI 1.32-2.13), intention/attempt to quit smoking (OR 1.27 95% CI 1.11-1.46), diabetes mellitus (OR 1.24 95% CI 1.03-1.51) and hospitalised duration (OR 1.09 95% CI 1.02-1.15). Variables associated with a lower likelihood of smoking cessation were depression (OR 0.57 95% CI 0.43-0.75), chronic obstructive pulmonary disease/lung disease (OR 0.73 95% CI 0.57-0.93), previous admission with acute myocardial infarction/cardiac admission (OR 0.61 95% CI 0.47-0.80), cerebrovascular disease/transient ischaemic attack (OR 0.42 95% CI 0.30-0.58) and unemployment (OR 0.37 95% CI 0.17-0.80). CONCLUSIONS The majority of smokers with an ACS continue to smoke after admission. Patients attending cardiac rehabilitation show increased odds of quitting while people who are depressed and those with chronic lung disease were less likely to quit smoking and should be targeted for intensive smoking cessation interventions.
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Affiliation(s)
- Saul Lovatt
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Chun Wai Wong
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Eric Holroyd
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Rob Butler
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Thanh Phan
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Ashish Patwala
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Yoon K Loke
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Chun Shing Kwok
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
- School of Medicine, Keele University, Stoke-on-Trent, UK
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García-Zamora S, Lépori AJ, Jordán A, Nauhm Y, Roif R, Paredes G, Sigal A, Ferrández-Escarabajal M, Pulido L, Álvarez-García J. [Manejo de la cesación tabáquica entre residentes de cardiología de Iberoamérica]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2021; 91:431-438. [PMID: 33938903 PMCID: PMC8641460 DOI: 10.24875/acm.20000381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introducción y objetivos: Si bien los cardiólogos asisten cotidianamente a pacientes que sufren daño por el tabaquismo, no se conoce el grado de formación que reciben sobre esta problemática durante su residencia. Debido a ello nos propusimos evaluar las preferencias y prácticas de los residentes de cardiología para la cesación tabáquica de los pacientes que asisten. Materiales y métodos: Encuesta cerrada, prefijada, voluntaria y anónima entre médicos que realizaban la especialidad de cardiología en cinco países de Latinoamérica y España. Resultados: Se encuestaron 716 residentes: un 62.4% de Argentina, un 19% de México, un 6.8% de España, un 6.7% de Chile, un 3.2% de Uruguay y un 1.9% de Paraguay. Con respecto a la importancia que asignaban a esta problemática (empleando una escala de 1-10), el 85.8% le asignó a esta pregunta una puntuación de 8 o mayor. Mientras el 80.5% de los participantes expresó dar consejo breve antitabáquico sistemáticamente, solamente un 27.7% empleaban terapia farmacológica con este fin. Entre quienes no empleaban terapia farmacológica, el 58.3% manifestó que el motivo era no encontrarse familiarizados con los tratamientos. El 62.9% de los encuestados dijo no haber recibido ningún tipo de formación en esta problemática. Aquellos residentes que recibieron algún tipo de formación manifestaron sentirse más preparados (p < 0.0001). Conclusión: Encontramos un bajo conocimiento sobre el tratamiento farmacológico y relativamente poca seguridad por parte de los residentes de cardiología para brindar asistencia en cesación tabáquica. Consideramos esencial incluir este tópico en la formación de los futuros cardiólogos a fin de lograr una prevención cardiovascular más integral.
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Affiliation(s)
| | - Augusto J Lépori
- Consejo Argentino de Residentes de Cardiología (CONAREC), Buenos Aires, Argentina
| | - Antonio Jordán
- Asociación de Fellows y Residentes Cardiólogos de México (ARCAME), Ciudad de México, México
| | - Yalile Nauhm
- Sociedad Chilena de Cardiología y Cirugía Cardiovascular (SOCHICAR), Santiago de Chile, Chile
| | - Romina Roif
- Comité de Cardiólogos en Formación de Uruguay (CCFUR), Montevideo, Uruguay
| | - Gabriel Paredes
- Instituto Nacional de Cardiología Prof. Dr. Juan A. Cattoni, Asunción, Paraguay
| | - Alan Sigal
- Consejo Argentino de Residentes de Cardiología (CONAREC), Buenos Aires, Argentina
| | | | - Laura Pulido
- Consejo Argentino de Residentes de Cardiología (CONAREC), Buenos Aires, Argentina
| | - Jesús Álvarez-García
- Servicio de Cardiología del Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau, CIBERCV, Universidad Autónoma de Barcelona, España
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Danielle Minc S, Budi S, Thibault D, Misra R, Armstrong DG, Stephen Smith G, Marone L. Opportunities for diabetes and peripheral artery disease-related lower limb amputation prevention in an Appalachian state: A longitudinal analysis. Prev Med Rep 2021; 23:101505. [PMID: 34381667 PMCID: PMC8339221 DOI: 10.1016/j.pmedr.2021.101505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/08/2021] [Accepted: 07/19/2021] [Indexed: 01/22/2023] Open
Abstract
Patients in the rural state of WV are at high-risk for atraumatic amputation. There are opportunities for improved diabetes and vascular disease management in WV. Patients at risk for vascular disease require preventive foot care and medication. Amputation may represent a sentinel event that promotes patient behavior change.
Lower extremity amputation due to peripheral artery disease (PAD) and diabetes (DM) is a life-altering event that identifies disparities in access to healthcare and management of disease. West Virginia (WV), a highly rural state, is an ideal location to study these disparities. The WVU longitudinal health system database was used to identify 1) risk factors for amputation, 2) how disease management affects the risk of amputation, and 3) whether the event of amputation is associated with a change in HbA1c and LDL levels. Adults (≥18 years) with diagnoses of DM and/or PAD between 2011 and 2016 were analyzed. Multivariable logistic regression analyses were performed on patients with lab information for both HbA1c and LDL while adjusting for patient factors to examine associations with amputations. In patients who underwent amputation, we compared laboratory values before and after using Wilcoxon signed rank tests. 50,276 patients were evaluated, 369 (7.3/1000) underwent amputation. On multivariable analyses, Male sex and Self-pay insurance had higher odds for amputation. Compared to patients with DM alone, PAD patients had 12.3 times higher odds of amputation, while patients with DM and PAD had 51.8 times higher odds of amputation compared to DM alone. We found significant associations between odds of amputation and HbA1c (OR 1.31,CI = 1.15–1.48), but not LDL. Following amputation, we identified significant decreases in lab values for HbA1c and LDL. These findings highlight the importance of medical optimization and patient education and suggest that an amputation event may provide an important opportunity for changes in disease management and patient behavior.
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Affiliation(s)
- Samantha Danielle Minc
- West Virginia University School of Medicine, Department of Cardiovascular and Thoracic Surgery, Division of Vascular and Endovascular Surgery, United States
- West Virginia University School of Public Health, Department of Occupational Health and Environmental Sciences, United States
- Corresponding author at: West Virginia University Medicine, 1 Medical Center Drive, PO Box 8003, Morgantown, WV 26506, United States.
| | - Stevan Budi
- West Virginia University School of Medicine, Department of General Surgery, United States
| | - Dylan Thibault
- West Virginia University School of Medicine, Department of Cardiovascular and Thoracic Surgery, Division of Vascular and Endovascular Surgery, United States
| | - Ranjita Misra
- West Virginia University School of Public Health, Department of Social and Behavioral Sciences, United States
| | - David G Armstrong
- University of Southern California Keck School of Medicine, Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, The Southwestern Academic Limb Salvage Alliance, United States
| | - Gordon Stephen Smith
- West Virginia University School of Public Health, Department of Epidemiology, United States
| | - Luke Marone
- West Virginia University School of Medicine, Department of Cardiovascular and Thoracic Surgery, Division of Vascular and Endovascular Surgery, United States
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9
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De Bacquer D, Astin F, Kotseva K, Pogosova N, De Smedt D, De Backer G, Rydén L, Wood D, Jennings C. Poor adherence to lifestyle recommendations in patients with coronary heart disease: results from the EUROASPIRE surveys. Eur J Prev Cardiol 2021; 29:383-395. [PMID: 34293121 DOI: 10.1093/eurjpc/zwab115] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/25/2021] [Accepted: 06/10/2021] [Indexed: 11/14/2022]
Abstract
AIMS Despite the high use of cardioprotective medications, the risk factor control in patients with coronary heart disease (CHD) is still inadequate. Guidelines identify healthy lifestyles as equally important in secondary prevention as pharmacotherapy. Here, we describe reasons for poor lifestyle adherence from the patient's perspective. METHODS AND RESULTS In the EUROASPIRE IV and V surveys, 16 259 CHD patients were examined and interviewed during a study visit ≥6 months after hospital discharge. Data gathering was fully standardized. The Brief Illness Perception questionnaire was completed by a subsample of 2379 patients. Half of those who were smoking prior to hospital admission, were still smoking; 37% of current smokers had not attempted to quit and 51% was not considering to do so. The prevalence of obesity was 38%. Half of obese patients tried to lose weight in the past month and 61% considered weight loss in the following month. In relation to physical activity, 40% was on target with half of patients trying to do more everyday activities. Less than half had the intention to engage in planned exercise. Only 29% of all patients was at goal for all three lifestyle factors. The number of adverse lifestyles was strongly related to the way patients perceive their illness as threatening. Lifestyle modifications were more successful in those having participated in a cardiac rehabilitation and prevention programme. Patients indicated lack of self-confidence as the main barrier to change their unhealthy behaviour. CONCLUSION Modern secondary prevention programmes should target behavioural change in all patients with adverse lifestyles.
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Affiliation(s)
- Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10-6K3, entrance 42, B-9000 Ghent, Belgium
| | - Felicity Astin
- Centre for Applied Research in Health, University of Huddersfield and Calderdale & Huddersfield NHS Foundation Trust, Huddersfield, UK
| | - Kornelia Kotseva
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland.,Imperial College Healthcare NHS Trust, London, UK
| | - Nana Pogosova
- National Medical Research Centre of Cardiology, Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10-6K3, entrance 42, B-9000 Ghent, Belgium
| | - Guy De Backer
- Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10-6K3, entrance 42, B-9000 Ghent, Belgium
| | - Lars Rydén
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - David Wood
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Catriona Jennings
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland.,Imperial College Healthcare NHS Trust, London, UK
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Bolívar HA, Elliott RJ, Middleton W, Yoon JH, Okoli CTC, Haliwa I, Miller CC, Ades PA, Gaalema DE. Social Smoking Environment and Associations With Cardiac Rehabilitation Attendance. J Cardiopulm Rehabil Prev 2021; 41:46-51. [PMID: 32925296 PMCID: PMC7755730 DOI: 10.1097/hcr.0000000000000518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Continued cigarette smoking after a major cardiac event predicts worse health outcomes and leads to reduced participation in cardiac rehabilitation (CR). Understanding which characteristics of current smokers are associated with CR attendance and smoking cessation will help improve care for these high-risk patients. We examined whether smoking among social connections was associated with CR participation and continued smoking in cardiac patients. METHODS Participants included 149 patients hospitalized with an acute cardiac event who self-reported smoking prior to the hospitalization and were eligible for outpatient CR. Participants completed a survey on their smoking habits prior to hospitalization and 3 mo later. Participants were dichotomized into two groups by the proportion of friends or family currently smoking ("None-Few" vs "Some-Most"). Sociodemographic, health, secondhand smoke exposure, and smoking measures were compared using t tests and χ2 tests (P < .05). ORs were calculated to compare self-reported rates of CR attendance and smoking cessation at 3-mo follow-up. RESULTS Compared with the "None-Few" group, participants in the "Some-Most" group experienced more secondhand smoke exposure (P < .01) and were less likely to attend CR at follow-up (OR = 0.40; 95% CI, 0.17-0.93). Participants in the "Some-Most" group tended to be less likely to quit smoking, but this difference was not statistically significant. CONCLUSION Social environments with more smokers predicted worse outpatient CR attendance. Clinicians should consider smoking within the social network of the patient as an important potential barrier to pro-health behavior change.
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Affiliation(s)
- Hypatia A Bolívar
- Vermont Center on Behavior and Health (Drs Bolívar, Ades, and Gaalema, Ms Elliott, and Mr Middleton) and Departments of Psychiatry (Drs Bolívar and Gaalema and Ms Elliott) and Psychology (Mr Middleton and Dr Gaalema), University of Vermont, Burlington; Departments of Psychiatry and Behavioural Sciences (Dr Yoon and Ms Haliwa) and Cardiothoracic and Vascular Surgery (Dr Miller), University of Texas Health Science at Houston; College of Nursing, University of Kentucky, Lexington (Dr Okoli); and Division of Cardiology, University of Vermont College of Medicine, Burlington (Dr Ades)
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11
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Gaalema DE, Bolívar HA, Khadanga S, Priest JS, Higgins ST, Ades PA. Current smoking as a marker of a high-risk behavioral profile after myocardial infarction. Prev Med 2020; 140:106245. [PMID: 32910931 PMCID: PMC7680426 DOI: 10.1016/j.ypmed.2020.106245] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/25/2020] [Accepted: 08/28/2020] [Indexed: 11/28/2022]
Abstract
Continued smoking following myocardial infarction (MI) is strongly associated with increased morbidity and mortality. Patients who continue to smoke may also engage in other behaviors that exacerbate risk. This study sought to characterize the risk profile of a national sample of individuals with previous MI who currently smoke. Data were taken from the 2017 Behavioral Risk Factor Surveillance Survey (United States), with 4.2% of the sample reporting a past MI (N = 26,004). Participants were classified by smoking status (current/former/never) and compared on medical comorbidities and the clustering of modifiable behaviors relevant for secondary prevention (smoking, poor nutrition, problematic alcohol use, physical inactivity, medication adherence). Current smokers were more likely to report other comorbidities including stroke, chronic obstructive pulmonary disease, physical limitations, and poor mental health. Smokers were also less likely to report taking blood pressure and cholesterol medications, and less likely to attend cardiac rehabilitation (examined in a subset of the sample, N = 2181). Current smoking remained an independent predictor of other health-related behaviors even when controlling for age, sex, race, educational attainment, and other comorbidities. In the modifiable risk-factor behavior cluster analysis, the most common pattern among current smokers was having two risk factors, smoking plus one additional risk factor, whereas the most common pattern was zero risk factors among never or former-smokers. Physical inactivity was the most common additional risk factor across smoking statuses. Current smoking is associated with multiple comorbidities and should be considered a marker for a high-risk behavioral profile among patients with a history of MI.
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Affiliation(s)
- Diann E Gaalema
- Vermont Center on Behavior and Health, United States; University of Vermont, Burlington, VT, United States.
| | - Hypatia A Bolívar
- Vermont Center on Behavior and Health, United States; University of Vermont, Burlington, VT, United States
| | - Sherrie Khadanga
- Vermont Center on Behavior and Health, United States; University of Vermont, Burlington, VT, United States; University of Vermont Medical Center, Burlington, VT, United States
| | - Jeffrey S Priest
- Vermont Center on Behavior and Health, United States; University of Vermont, Burlington, VT, United States
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, United States; University of Vermont, Burlington, VT, United States
| | - Philip A Ades
- Vermont Center on Behavior and Health, United States; University of Vermont, Burlington, VT, United States; University of Vermont Medical Center, Burlington, VT, United States
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12
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Sadeghi M, Shabib G, Masoumi G, Amerizadeh A, Shahabi J, Heidari R, Roohafza H. A Systematic Review and Meta-analysis on the Prevalence of Smoking Cessation in Cardiovascular Patients After Participating in Cardiac Rehabilitation. Curr Probl Cardiol 2020; 46:100719. [PMID: 33160685 DOI: 10.1016/j.cpcardiol.2020.100719] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 09/19/2020] [Indexed: 12/18/2022]
Abstract
Smoking is the most important modifiable cardiovascular risk factor causes around approximately one of every 4 cardiovascular-related deaths worldwide. Cardiac rehabilitation (CR) is the standard way of management of heart diseases after myocardial infraction. This study aimed to determine the prevalence of cardiovascular patients' quit smoking after participation in CR. PubMed, EMBASE, Web of Science, Scopus, and google scholar were searched systematically. In total, 18 studies were analyzed. Results showed that the mean age of smokers' were 54.80 (52.06, 57.55), and of them 53 % (22%, 83%) quit smoking after participating in CR. Subgroup analysis showed that among type of CR the most effective one was the educational along with physical exercise (comprehensive CR) cause 99% (98%, 100%) smoking cessation (SC). Group-based methods with76% (57%, 94%) of quitters showed to be more effective than individual-based. It can be concluded that CR has been effective in terms of smoking cessation.
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Affiliation(s)
- Masoumeh Sadeghi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Ghadir Shabib
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gholamreza Masoumi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Atefeh Amerizadeh
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Javad Shahabi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ramin Heidari
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamdreza Roohafza
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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13
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Riley H, Ainani N, Turk A, Headley S, Szalai H, Stefan M, Lindenauer PK, Pack QR. Smoking cessation after hospitalization for myocardial infarction or cardiac surgery: Assessing patient interest, confidence, and physician prescribing practices. Clin Cardiol 2019; 42:1189-1194. [PMID: 31647127 PMCID: PMC6906990 DOI: 10.1002/clc.23272] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/30/2019] [Accepted: 09/10/2019] [Indexed: 01/08/2023] Open
Abstract
Background Prioritizing and managing multiple behavior changes following a cardiac hospitalization can be difficult, particularly among smokers who must also overcome a serious addiction. Hypothesis Hospitalized smokers will report a strong interest in smoking cessation (SC) but will receive little assistance from their physicians. Methods We asked current smokers hospitalized for an acute cardiac event to prioritize their health behavior priorities, and inquired about their attitude toward SC therapies. We also assessed SC cessation prescriptions provided by their physicians. Results Of the 105 patients approached, 81 (77%) completed the survey. Of these, 72.5% ranked SC as their greatest health change priority, surpassing all other behavior changes, including: taking medications, attending cardiac rehabilitation (CR), dieting, losing weight, and attending doctor appointments. Patients felt that SCM (44%), CR (41%), and starting exercise (35%) would increase their likelihood for SC. While most patients agreed that smoking was harmful, 16% strongly disagreed that smoking was related to their hospitalization. At discharge, medication was prescribed to ~32% of patients, with equal frequency among patients who reported interest and those who reported no interest in using medications. Conclusion The majority of hospitalized smokers with cardiac disease want to quit smoking, desire help in doing so, and overwhelmingly rate cessation as their highest health behavior priority, although some believe smoking is unrelated to their disease. The period following an acute cardiac event appears to be a time of great receptivity to SC interventions; however, rates of providing tailored, evidence‐based interventions are disappointingly low.
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Affiliation(s)
- Hayden Riley
- Division of Cardiovascular Medicine, Baystate Medical Center, Springfield, Massachusetts.,Department of Exercise Science and Sports Studies, Springfield College, Springfield, Massachusetts.,Cardiac and Pulmonary Rehabilitation, The Miriam Hospital, Providence, Rhode Island
| | - Nitesh Ainani
- Division of Cardiology, Baystate Medical Center, Springfield, Massachusetts
| | - Ahmad Turk
- Division of Cardiology, Baystate Medical Center, Springfield, Massachusetts
| | - Samuel Headley
- Department of Exercise Science and Sports Studies, Springfield College, Springfield, Massachusetts
| | - Heidi Szalai
- Division of Cardiology, Baystate Medical Center, Springfield, Massachusetts
| | - Mihaela Stefan
- Institute for Health Care Delivery and Population Science, Baystate Medical Center, Springfield, Massachusetts.,Department of Internal Medicine, Baystate Medical Center, Springfield, Massachusetts.,University of Massachusetts Medical School at Baystate, Springfield, Massachusetts
| | - Peter K Lindenauer
- Institute for Health Care Delivery and Population Science, Baystate Medical Center, Springfield, Massachusetts.,Department of Internal Medicine, Baystate Medical Center, Springfield, Massachusetts.,University of Massachusetts Medical School at Baystate, Springfield, Massachusetts
| | - Quinn R Pack
- Division of Cardiovascular Medicine, Baystate Medical Center, Springfield, Massachusetts.,Division of Cardiology, Baystate Medical Center, Springfield, Massachusetts.,Institute for Health Care Delivery and Population Science, Baystate Medical Center, Springfield, Massachusetts
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