Myocardial infarction: brief advice was not clearly worse than a more detailed intervention at helping smokers quit

Clinical bottom line (level 1b-)

  1. Patients wanting to stop smoking following a myocardial infarction who received a 30 minute detailed intervention compared with brief advice and a leaflet were not clearly less likely to have stopped smoking at 6 weeks or 12 months.
Hajek et al: British Medical Journal 2002; 324 : 87-89
Expires March 2004

The study

Unblinded ?concealed randomised trial without intention-to-treat
Setting: inpatient wards, 17 acute hospitals, UK

540 patients (aged mean 56, 77% male) admitted with a myocardial infarction (94%) or or for CABG, who expressed a desire to stop smoking

Excluded if
  • too unwell to receive intervention
  • gross memory impairment
  • aged 76 or more
  • able to read English
  • smoked since admission to hospital
  • not motivated to stop smoking permanently

Control Group: (n = 266, 251 analysed): brief verbal advice and standard booklet
Experimental Group: (n = 274, 254 analysed): intervention lasting 20-30 minutes involving carbon monoxide reading, special booklet, quiz, contact with other people giving up, declaration of commitment to give up, sticker in patient's notes

94% followed for 12 months

The evidence

Outcome Time to outcome CER EER RRR
(95% CI)		 ARR
(95% CI)		 NNT
(95% CI)
stopped smoking 6 weeks 152
(60.6%)		 159
(62.6%)		 -3%
(-19% to 10%)		 -2.04%
(-10.5% to 6.44%)		 -49
(NNT = 16 to infinity;
NNH = 10 to infinity)
stopped smoking 12 months 102
(40.6%)		 94
(37.0%)		 9%
(-13% to 27%)		 3.63%
(-4.87% to 12.1%)		 28
(NNT = 8 to infinity;
NNH = 21 to infinity)

Citation

  1. Hajek P, Taylor TZ, Mills P: brief intervention during hospital admission to help patients to give up smoking after myocardial infarction and bypass surgery: randomised controlled trial. British Medical Journal 2002; 324 : 87-89
Search Terms: from ACP Journal Club other articles noted
Contributor: Chris Ball, March 2002
Reviewer:

Clinical Question.
Patient myocardial infarction, CABG
Intervention or Exposure advice on quitting smoking
Outcome smoking cessation