Myocardial infarction: reinforced advice on giving up smoking helped.

Clinical bottom line (level 2c)

  1. Two-thirds of male smokers who had a myocardial infarction gave up smoking after reinforced advice on giving up and follow-up out of hospital.
  2. A quarter of patients given only conventional advice to stop smoking, gave up.
  3. A tenth reduced their cigarette intake to less than 10.
  4. A tenth reduced their cigarette intake to less than 15.
  5. 3% changed to smoking a pipe.
  6. A sixth did not change their habits.
Burt et al: Lancet 1974; : 304-306
Expires March 2003

The study

Prospective cohort study with objective outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: coronary care unit, UK

160 patients (aged ?, 100% male) acute myocardial infarction, who were smokers or non-smokers
Patients were advised to stop smoking by a consultant, and this was later reinforced by junior medical staff and nurses. They were told that they should never smoke again, and it was stated that no guarantee of future health could be given as the habit had been present for many years, but that the chance of a recurrent infarction was likely to be less. It was never recommended that smoking should just be reduced, but in patients who did not give up were given conventional advice on how to reduce their smoking. Motivation was continued after discharge, and advice was also extended to the family. 98 patients were given conventional advice with no hospital follow-up.


Outcomes studied:
  • percentage of patients who stopped smoking
  • percentage of smokers who reduced cigarettes to <10
  • percentage of smokers who reduced cigarettes to <15
  • percentage of smokers who changed to a pipe
  • percentage of smokers who did not change their habit
  • percentage of patients only given conventional advice who stopped

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    percentage of patients who stopped smoking ? 79/125 63.2%
    (54.7% to 71.7%)
    percentage of smokers who reduced cigarettes to <10 ? 11/125 8.80%
    (3.83% to 13.8%)
    percentage of smokers who reduced cigarettes to <15 ? 12/125 9.60%
    (4.43% to 14.8%)
    percentage of smokers who changed to a pipe ? 4/125 3.20%
    (0.12% to 6.29%)
    percentage of smokers who did not change their habit ? 19/125 15.2%
    (8.91% to 21.5%)
    percentage of patients only given conventional advice who stopped ? 27/98 27.6%
    (18.7% to 36.4%)

    • 35 patients were non-smokers at the start of the investigation and remained non-smokers.

    Comments

    1. This quit rate is considerably higher than the quit rate in any trial since and most likely can be explained by the lack of biochemical markers to confirm abstinence in this study.

    Citation

    1. Burt A, Thornley P, Illingworth D, et al: Stopping smoking after myocardial infarction. Lancet 1974; : 304-306
    Contributor: Clare Wotton and Musab Hayatli, January 2000
    Reviewer: Kenneth Ballew

    Clinical Question.
    Patient myocardial infarction and smokers
    Intervention or Exposure advised to give up smoking
    Outcome stopped smoking